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SU_10_2101 - A Chinese Multi-Institutional Analysis of Three Dimensional Conformal Radiation or Intensity-Modulated Radiation Therapy for Non-Operated Localized Esophageal Squamous Cell Carcinoma in Definitive (Chemo)Radiation
Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3
A Chinese Multi-Institutional Analysis of Three Dimensional Conformal Radiation or Intensity-Modulated Radiation Therapy for Non-Operated Localized Esophageal Squamous Cell Carcinoma in Definitive (Chemo)Radiation
X. Wang1, L. Wang2, J. Q. Chen3, W. Zhang4, X. M. Wang5, X. L. Ge6, M. M. Hu7, C. L. Hao7, Y. Xu8, Z. G. Zhou9, N. Lu10, S. Qie11, Q. S. Pang4, Y. D. Zhao5, X. C. Sun6, K. X. Zhang7, G. Li8, X. Qiao9, Y. T. Wang10, M. L. Liu11, C. Li1, W. Deng1, W. Ni1, X. Chang1, L. Deng1, W. Q. Wang1, J. Liang12, Z. Zhou12, S. Zhu2, Z. Xiao1, and C. Han2; 1Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, 2Department of Radiation Oncology , the Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 3Departments of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China, 4Department of Radiation oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention Therapy, Tianjin, China, 5Anyang Tumor Hospital, Henan Province, China, 6Jiangsu Province Hospital, Jiangsu Province, China, 7TengZhou Central People’s hospital, Tengzhou, Shandong Province, China, 8Beijing Hospital, Beijing, China, 9Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 10PLA Army General Hospital, Beijing, China, 11Affiliated Hospital of Hebei University, Baoding, China, 12Department of Radiation Oncology, National Cancer Center / Cancer Institute & Hospital, Chinese Academic of Medical Sciences, Peking Union Medical College, Beijing, China
Purpose/Objective(s): Large-scale reports on survival outcomes of Chinese patients with esophageal cancer are scarce. The aim of this study is to investigate the impact of definitive (chemo)radiotherapy using three dimensional conformal radiation (3DCRT) or intensity-modulated radiotherapy (IMRT) on survival outcomes in non-operated localized esophageal squamous cell carcinoma (LESCC).
Materials/Methods: A total of 2762 patients with LESCC extracted from 3325 patients primarily treated in ten Chinese institutions between 2001 and 2015 were retrospectively analyzed. The enrolled criteria included: age>18, histologically confirmed squamous cell carcinoma, staged as cT1-4N0-1M0-M1b (according to AJCC 6th) without visceral metastasis and no metastatic lymph nodes other than supraclavicular or celiac trunk area, treated with 3DCRT or IMRT, prescription dose ≥40Gy, no prior thoracic radiation or chemotherapy and follow-up time ≥6 months for patients alive. The overall survival (OS) was calculated with the Kaplan-Meier method and possible prognostic factors were analyzed based on COX regression.
Results: Median age was 65 years (range, 30-90), and most patients were male (68.9%). Primary tumor location in cervical, upper, middle and lower of esophagus were determined in 4.8%, 28.4%, 45.4% and 20.5%. The median length of tumor was 5cm (range, 1-19). The median target volume of primary tumor and metastatic lymph node (GTVv) was 43.9cm3 (range, 1-293). The patients were clinically staged as stage I (0.8%), IIa/b (24.7%), III (52.5%), and IVa/b (22%). Treatment including chemoradiotherapy (CRT), CRT plus adjuvant chemotherapy (CRT+CT), radiotherapy (RT), RT plus adjuvant chemotherapy (RT+CT) were 32.2%, 10.6%, 50.7%, and 6.5% of the patients. With a median follow-up of 60.8 months, the 5-year OS and median survival time (MST) were 30.9% and 23.0 months for the whole group. OS and MST based on clinical stage were stage I, 67.6% and 66 months, stage IIa, 46.3% and 51.3 months, stage IIb, 35.9% and 25.8 months, stage III, 27.7% and 21.8 months, stage IVa, 24.3% and 17.1 months, stage IVb, 23.5% and 16.8 months. In the multivariate analysis, age>68 (HR: 1.14, 95% CI: 1.03-1.26, P = 0.014), female (HR: 0.90, 95% CI: 0.81-0.99, P = 0.051), length > 5cm (HR: 1.10, 95% CI: 1.0-1.22, P = 0.055), clinical stage IVa/b (HR: 2.54, 95% CI: 1.34-4.8, P = 0.004), CRT+CT (HR: 0.79, 95% CI: 0.66-0.95, P = 0.012), RT dose ≥60Gy (HR: 0.59, 95% CI:0.38-0.91, P =0.017) and GTVv > 50cm3 (HR: 1.38, 95% CI:1.25-1.53, P < 0.001) were independent prognostic factors. While, radiotherapy technique (3D-CRT vs IMRT) and tumor location did not significantly impacted on prognosis.
Conclusion: Compared with contemporary outcomes, this cohort had better prognosis even nearly two thirds of patients with locally advanced stage III or IV esophageal cancer. These results may be due to the superior radiotherapy techniques and chemotherapy applied. We will conduct further analysis to provide more scientific evidence for individualized treatment in LESCC.
Author Disclosure: X. Wang: None. W. Zhang: None. X. Ge: None. C. Hao: None. Z.g. Zhou: None.