Clinical outcomes in different target volume for cervical and upper-thoracic esophageal cancer in definitive chemoradiotherapy

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Objective To investigate the prognostic effects and failure patterns of different clinical target volumes of IMRT in definitive chemoradiotherapy for cervical and upper-thoracic esophageal cancer, in order to provide a reference for radiotherapy target area delineation. Methods A retrospective analysis was performed on the clinical data of 132 patients with cervical and upper-thoracic esophageal cancer who received definitive IMRT and concurrent chemotherapy in our hospital from 2010 to 2014. Seventy-one patients received elective nodal irradiation (ENI) and the other 61 patients received involved-field irradiation (IFI). The Kaplan-Meier method was used to calculate local control (LC), progression-free survival (PFS) and overall survival (OS) rates. The significant difference was evaluated by the log-rank test. The prognostic factors were determined by Cox univariate and multivariate analyses. Results The last follow-up time was December 2017, the median follow-up time was 59.5 (14.2- 95.8) months. Follow-up rate was 99.2%. For the ENI and IFI groups, the 1-, 3-, 5- year LC were 77.5%, 58.8%, 48.8% vs. 64.3%, 29.1%, 26.2% (χ2=9.68, P=0.002), PFS were 68.6%, 37.7%, 25.9% vs. 47.5%, 17.2%, 3.6% (χ2=11.39, P=0.001), OS were 81.7%, 53.9%, 31.3% vs. 70.5%, 31.9%, 16.3% (χ2=7.70, P=0.006), respectively. In multivariate analysis, T stage, N stage, and RT field were independent factors for LC, PFS and OS(P 0.05). Conclusions Compared with IFI, ENI can significantly reduce local-regional recurrence and distant metastasis and improve the long-term survival for cervical and upper-thoracic esophageal cancer patients who received definitive chemoradiotherapy.