The curative effect of concurrent chemoradiotherapy for the part of patients with mediastinal lymph nodes after esophagectomy

ZHOU Shaobing; DING Wenxiu; GUO Xinwei; LIU Yangchen

Abstract：Objective To evaluate the influence of gross tumor volume( GTV) >40 cm3 of mediastinal lymph nodes on the curative effect of patients with esophageal cancer receiving concurrent chemoradiotherapy after esophagectomy. Methods From June 2010 to November 2012, sixty patients with GTV >40 cm3 of mediastinal lymph nodes were randomly assigned to receive three dimen-sional conformal radiotherapy ( control group, n=30) and concurrent chemoradiotherapy ( treatment group, n=30) . As for radiothera-py, the total radiation dose was 60-64 Gy at a fraction of 2 Gy with 5 f/week. Treatment group received paclitaxel and cisplatin (TP) regime additionally. Response to chemotherapy was assessed by RECIST criteria 1. 1 and toxicity was evaluated according to RGOT standard. The clinical follow-up data from chemotherapy were investigated. Results All patients were available for evaluation. The total response rate ( RR) and disease control rate ( DCR) were 86. 7% and 100. 0% in treatment group, and 60. 0% and 96. 7% in control group. The RR of treatment group was higher than that of control group ( P<0. 05) . No significant difference was observed on DCR between both groups ( P>0. 05) . The median overall survival of the treatment group and the control group were 27. 0 months and 22. 0 months, respectively, and the difference was statistically significant ( P<0. 05 ) . The 1-, 2- and 3-year survival rates were 90. 0%, 53. 3% and 26. 7% in treatment group and 73. 3%, 23. 3% and 6. 7% in control group, respectively. The difference of 3-year survival rate between both groups was statistically significance ( P<0. 05) . The adverse reactions of the whole group were mainly of ra-dioactive esophagitis, radiation pneumonia, gastrointestinal reaction and bone marrow suppression, all of which were 1-2 grade, and there was no 3-4 grade adverse reaction. There was no significant difference in adverse reactions between both groups ( P>0. 05) . Con-clusion Concurrent chemoradiotherapy improved the local control rate and survival rate for GTV>40 cm3 of mediastinal lymph node metastasis after esophagectomy with mild and tolerated adverse reaction.