The concurrent control study of elective nodal prophylactic irradiation with intensity modulated radiotherapy for esophageal carcinoma

Objective To explore the value of elective nodal prophylactic irradiation with intensity modulated radiotherapy(IMRT) for esophageal carcinoma.Screening patients who are suitable for elective nodal prophylactic irradiation (ENI),in order to improve locoregional control and overall survival.Methods The concurrent control study was conducted to esophageal cancer patients who were treated by definitive radiotherapy.A total of 148 patients finished treatment were identified.Seventy-four patients received ENI,while the other seventy-four patients received involved-field irradiation (IFI).Kaplan-Meier method was used for calculation of locoregional control rates and overall survival rates.The univariate and multivariate analysis of prognostic factors were also tested.Results The 1-,3-,and 5-year locoregional control rates of ENI group and IFI group were 72.5％,52.8％,50.6％ and 58.4％,35.8％,21.9％ (x2 =7.881,P ＜0.05),respectively.The 1,3,and 5 years survival rates of the ENI group and IFI group were 74.3％,44.2％,24.5％ and 68.9％,27.6％,15.9％ (x2 =1.903,P ＜ 0.05),respectively.In Cox multivariate analysis,clinical T stage,tumor location,different radiotherapy region were independent factors for the locoregional control of all patients,and clinical T,N stage,the length of esophageal barium meal and chemotherapy were independent factors for the overall survival of all patients.Conclusions Esophageal carcinoma patients treated with ENI could achieve better locoregional control than those treated with IFI.Esophageal carcinoma patients with early stage or middle thoracic lesion could benefit from ENI for local control and overall survival. Key words: Esophageal carcinoma;  Radiotherapy;  Elective nodal prophylactic irradiation;  Involved-field irradiation;  Concurrent control