[Long-term outcomes and failure patterns of definitive radiotherapy for cervical esophageal carcinoma].

Objective: To evaluate the long-term outcomes, failure patterns and prognostic factors of definitive radiotherapy in patients with cervical esophageal carcinoma (CEC). Methods: We retrospectively reviewed the clinical data of 148 CEC patients who treated with definitive radiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from January 2001 to December 2017. The median radiation dose was 66 Gy (59.4-70 Gy) and 33.1% of patients received concurrent chemotherapy. The Kaplan-Meier method was used to calculate survival rates. The log rank test was used for survival comparison and univariate prognostic analysis. The Cox model was used for multivariate prognostic analysis. Results: The median follow-up time was 102.6 months. The median survival time, 2- and 5-year overall survival (OS) were 22.7 months, 49.9% and 28.3%. The median, 2- and 5-year progression-free survival were 12.6 months, 35.8% and 25.8%. The 2- and 5-year locoregional recurrence-free survival were 59.1% and 50.8%. The 2- and 5-year distant metastases-free survival were 74.6% and 65.9%. Multivariate analysis showed that EQD(2)>66 Gy was the only independent prognostic indicator for OS (P=0.040). The median survival time and 5-year OS rate significantly improved in patients who received EQD(2)>66 Gy than those who received≤66 Gy (31.2 months vs. 19.2 months, 40.1% vs. 19.1%, P=0.027). A total of 87 patients (58.8%) developed tumor progression. There were 50 (33.8%), 23 (15.5%) and 39 (26.4%) patients developed local, regional recurrence and distant metastases, respectively. Eleven patients (7.4%) underwent salvage surgery, and the laryngeal preservation rate for entire group was 93.9%. Conclusions: Definitive radiotherapy is an effective treatment for cervical esophageal carcinoma with the advantage of larynx preservation. Local recurrence is the major failure pattern. EQD(2)>66 Gy is associated with the improved overall survival.目的：探讨颈段食管癌根治性放疗的长期疗效、治疗失败模式及预后影响因素。 方法：回顾性分析2001年1月至2017年12月于中国医学科学院肿瘤医院诊治的148例颈段食管鳞癌患者的临床资料。全组148例患者的中位放疗剂量为66.0 Gy(59.4~70.0 Gy)，33.1%(49/148)的患者进行了同步化疗。采用Kaplan－Meier法计算生存率，Log rank检验比较生存差异及单因素分析，多因素分析采用Cox比例风险回归模型。 结果：全组148例患者的中位随访时间为102.6个月，中位生存时间为22.7个月，2、5年生存率分别为49.9%和28.3%；疾病中位进展时间为12.6个月，2、5年无进展生存率分别为35.8%和25.8%；2、5年无局部区域复发生存率分别为59.1%和50.8%；2、5年无远处转移生存率分别为74.6%和65.9%。多因素分析显示，2 Gy分次放疗等效剂量(EQD(2))>66 Gy是影响总生存的独立预后因素(P＝0.040)。EQD(2)>66 Gy患者的中位生存时间(31.2个月)和5年生存率(40.1%)优于EQD(2)≤66 Gy患者(分别为19.2个月和19.1%，P＝0.027)。全组148例患者中，治疗失败87例(58.8%)，局部复发50例(33.8%)，区域复发23例(15.5%)，远处转移39例(26.4%)。11例(7.4%，11/148)患者行挽救性手术治疗，全组保喉率为93.9%(139/148)。 结论：根治性放疗是颈段食管癌的有效治疗手段且具有保喉优势，局部复发是主要的治疗失败模式，予以肿瘤EQD(2)>66 Gy的放疗剂量有利于提高患者的总生存率。.