Comparison of different treatment modalities in patients with esophageal carcinoma received intensity-modulated radiotherapy

Objective To investigate long-term efficacy in patients with esophageal carcinoma received different intensity-modulated radiotherapy (IMRT) modalities, and to analyze the reasons for treatment failure. Methods A total of 349 esophageal cancer patients was analyzed in the study. The cases who underwent IMRT only, IMRT with concurrent chemotherapy and IMRT followed by sequential chemotherapy was 169 (48.4%), 121 (34.7%), and 59 (16.9%), respectively. The short-term efficacy, acute toxicity, 1-, 3-, 5-year local control and survival rates in three different treatment strategy were evaluated. The effect of different treatment modalities on local control and survival was analyzed, meanwhile side-effects were observed, and treatment failure reason was also analyzed. Results The 1-, 3- and 5-year survival rates were 72.7%, 46.0%, and 35.9% in concurrent chemoradiotherapy group, while 64.4%, 35.1%, and 24.3% in sequential chemoradiotherapy group, and 62.7%, 36.1%, and 17.2% in IMRT only group. The 1-, 3- and 5-year survival rates in concurrent chemo-radiotherapy were improved when compared to those in radiotherapy only (χ2=5.631, P=0.018). The 1-, 3- and 5-year local controlled rates were 76.2%, 67.3%, and 60.9% in concurrent chemoradiotherapy group, 74.9%, 49.2%, and 46.9% in sequential chemoradiotherapy group, and 70.4%, 59.7%, and 51.3% in radiotherapy only group. There was no significant difference among three groups (χ2=2.569, P=0.277). The acute rate of hematologic toxicity was increased when IMRT combined with chemotherapy versus radiotherapy only (χ2=42.550, P=0.000). The bone marrow suppression rate ≥ grade II in concurrent chemoradiotherapy group was 47.9% (58/121), and 42.4% (25/59) in sequential chemoradiotherapy group, and 16.6% (28/169) in radiotherapy only group It showed that FP regimen and TP regimen had the similar efficacy both in local control and suuvival (χ2=0.108, P=0.742; χ2=0.004, P=0.948). Conclusions Comparing IMRT only group, the long-term survival rates in IMRT with concurrent chemotherapy are increased significantly, while sequential chemoradiotherapy group has no advantage, so the latter is not recommended. Chemoradiotherapy strategy increases the risk of acute hematologic toxicity when compared to that in radiotherapy only. There is no significant difference in efficacy between FP and TP regimen. Key words: Esophageal neoplasms/RT; Radiotherapy, intensity-modulated/MT