Analysis of failure patterns of three-dimensional conformal radiotherapy alone in resectable esophageal cancer

Objective To analyse the outcome of patients with resectable esophageal squamous cell carcinoma after receiving three-dimensional conformal radiotherapy (3DCRT) alone,and to provide a reference for accurate prognosis prediction and better therapeutic effect.Methods A retrospective analysis was performed in 92 patients with esophageal cancer,who received radical 3DCRT in our hospital from February 2002 to July 2007,to determine the reasons for treatment failure.The recurrence,metastasis,local control,and survival were calculated by the Kaplan-Meier method ;the influential factors for recurrence and metastasis were analyzed using the Cox model.Results The overall failure rate was 51％ (47/92) ;of the 47 patients,29 had regional recurrence,12 had distant metastasis,and 6 had both distant metastasis and regional recurrence.In the patients with regional recurrence,there were more individuals with middle thoracic esophageal cancer than individuals with upper and lower thoracic esophageal cancers (23 vs 8 and 4,x2 =39.36,P =0.000),and there were more individuals with a partial remission than individuals with a complete remission (18 vs 7,x2 =23.44,P =0.000).In the patients with distant metastasis,there were more individuals with lower thoracic esophageal cancer than individuals with upper and middle thoracic esophageal cancers (7 vs 6 and 5,x2 =14.42,P =0.001).The multivariate analysis showed that N stage,clinical stage,and short-term efficacy were the influential factors for regional recurrence and that N stage,clinical stage,length of tumor on X-ray film,and short-term efficacy were the influential factors for distant metastasis.Conclusions After receiving 3DCRT alone,the patients with upper thoracic esophageal cancer have lower regional recurrence and distant metastasis rates than those with middle and lower thoracic esophageal cancers,and the patients with a complete remission have lower regional recurrence and distant metastasis rates than those with a partial remission.Clinical stage is still an important influential factor for regional recurrence and distant metastasis. Key words: Esophageal neoplasms/three-dimensional conformal radiotherapy;  Failure pattern; Factors analysis