Background
Methods
Patients
Characteristics | Total (%) | EBRT + NBT (%) | 3D-CRT (%) |
P value* | 5y OS (%) |
P value | 5y LC (%) |
P value |
---|---|---|---|---|---|---|---|---|
Gender | <0.0001 | 0.174 | 0.312 | |||||
Male | 583 (66.0) | 324 (59.4) | 259 (76.4) | 24.5 | 44.7 | |||
Female | 301 (34.0) | 221 (40.6) | 80 (23.6) | 30.8 | 51.9 | |||
Age (years) | 0.003 | 0.291 | 0.591 | |||||
≤65 | 426 (48.2) | 284 (52.1) | 142 (41.9) | 29.9 | 48.3 | |||
>65 | 458 (51.8) | 261 (47.9) | 197 (58.1) | 23.5 | 46.4 | |||
Tumor length | 0.220 | <0.0001 | <0.0001 | |||||
≤5 cm | 409 (46.3) | 261 (47.9) | 148 (43.7) | 31.0 | 52.4 | |||
>5 cm | 475 (53.7) | 284 (52.1) | 191 (56.3) | 22.9 | 42.4 | |||
Tumor location | <0.0001 | 0.233 | 0.581 | |||||
Upper | 329 (37.2) | 174 (31.9) | 155 (45.7) | 26.9 | 49.2 | |||
Middle | 442 (50.0) | 309 (56.7) | 133 (39.2) | 27.8 | 45.6 | |||
Lower | 113 (12.8) | 62 (11.4) | 51 (15.0) | 20.9 | 46.4 | |||
T stage | 0.006 | <0.0001 | <0.0001 | |||||
T1 | 32 (3.6) | 20 (3.7) | 12 (3.5) | 64.1 | 73.1 | |||
T2 | 163 (18.4) | 107 (19.6) | 56 (16.5) | 32.9 | 51.7 | |||
T3 | 305 (34.5) | 164 (30.1) | 141 (41.6) | 31.2 | 53.9 | |||
T4 | 384 (43.4) | 254 (46.6) | 130 (38.3) | 17.6 | 37.7 | |||
N stage | <0.0001 | <0.0001 | ||||||
N0 | 461 (52.1) | 338 (62.0) | 123 (36.3) | 32.6 | 53.2 | |||
N1 | 423 (47.9) | 207 (38.0) | 216 (63.7) | 20.2 | 40.0 | |||
AJCC stage | <0.0001 | <0.0001 | <0.0001 | |||||
I | 28 (3.2) | 20(3.7) | 8 (2.4) | 72.3 | 74.5 | |||
IIa | 280 (31.7) | 195 (35.8) | 85 (25.1) | 36.0 | 56.6 | |||
IIb | 55 (6.2) | 22 (4.0) | 33 (9.7) | 29.3 | 35.2 | |||
III | 521 (58.9) | 308 (56.5) | 213 (62.8) | 19.2 | 41.1 | |||
Radiation dose | <0.0001 | 0.263 | 0.658 | |||||
≤60Gy | 321 (36.3) | 91 (16.7) | 230 (67.8) | 22.9 | 44.7 | |||
>60Gy | 563 (63.7) | 454 (83.3) | 109 (32.2) | 29.0 | 48.6 |
Radiotherapy
Group 1: NBT + EBRT
Group 2: 3D-CRT (i.e. EBRT-only)
Toxicity assessment and follow-up
Statistical analysis
Results
Patient characteristics and treatments
Univariate and multivariate analysis of OS and LC rates
Factors | OS rate | LC rate | ||
---|---|---|---|---|
HR (95 % CI) |
P value | HR (95 % CI) |
P value | |
Tumor length (≤5 cm vs >5 cm) | 0.81 (0.68–0.96) | 0.014 | 0.73 (0.58–0.92) | 0.007 |
T stage (T1 + T2 vs T3 + T4) | 0.84 (0.63–1.13) | 0.257 | 0.85 (0.58–1.24) | 0.398 |
N stage (N0 vs N1) | 0.89 (0.73–1.09) | 0.260 | 0.90 (0.68–1.18) | 0.432 |
AJCC Stage (I + II vs III) | 0.62 (0.52–0.74) | <0.0001 | 0.66 (0.52–0.84) | 0.001 |
Treatment modality (3D–CRT vs NBT + EBRT) | 1.27 (1.07–1.20) | 0.005 | 1.26 (1.01–1.58) | 0.043 |
Subgroup analyses on OS and LC rates
Characteristics | EBRT + NBT | 3D-CRT |
P value |
---|---|---|---|
Stage I + II |
n = 237 |
n = 126 | |
5-year LC | 59.9 % | 46.1 % | 0.045 |
5-year OS | 43.9 % | 28.6 % | 0.004 |
Median survival | 45.5 months | 25.9 months | 0.004 |
Stage III |
n = 308 |
n = 213 | |
5-year LC | 44.9 % | 33.2 % | 0.306 |
5-year OS | 23.2 % | 12.8 % | 0.175 |
Median survival | 15.6 months | 15.5 months | 0.175 |
Overall |
n = 545 |
n = 339 | |
5-year LC | 51.4 % | 38.1 % | 0.019 |
5-year OS | 32.0 % | 18.4 % | 0.001 |
Median survival | 21.7 months | 19.1 months | 0.001 |
Toxicity and pattern of failure
Characteristics | EBRT + NBT (n = 545) | 3D-CRT (n = 339) |
P value |
---|---|---|---|
Acute toxicity (Events of grade ≥2) | Number of patients (%) | ||
Esophagitis | 197 (36.1 %) | 122 36.0 %) | 0.962 |
Pulmonary complications | 30 (5.5 %) | 10 (2.9 %) | 0.076 |
Leukopenia | 425 (78.0 %) | 209 (61.7 %) | <0.001 |
Neutropenia | 282 (51.7 %) | 165 (48.7 %) | 0.375 |
Thrombocytopenia | 54 (9.9 %) | 8 (2.4 %) | <0.001 |
Late toxicity | |||
Esophageal fistulas | 33 (6.1 %) | 47 (13.9 %) | <0.001 |
Massive bleeding | 27 (5.0 %) | 20 (5.9 %) | 0.831 |
The sites of first failure in the whole group | |||
Local-regional failure | 195 (35.7 %) | 139 (41.0 %) | 0.001 |
In field | 170 (31.2 %) | 124 (36.6 %) | 0.001 |
Out field | 25 (4.6 %) | 15 (4.4 %) | 0.116 |
Distant metastasis | 86 (15.8 %) | 41 (12.1 %) | 0.128 |
Lung | 23 (4.2 %) | 14 (4.1 %) | NS |
liver | 14 (2.6 %) | 8 (2.4 %) | NS |
Bone | 14 (2.6 %) | 3 (0.9 %) | NS |
Brain | 5 (1.0 %) | 3 (0.9 %) | NS |
≥2 metastasis sites | 30 (5.5 %) | 13 (3.8 %) | NS |
Not otherwise specified (disease of heart head blood-vessel, pneumonia, second tumor) | 36 (6.6 %) | 35 (6.4 %) | NS |