Concurrent chemoradiotherapy versus radiotherapy alone for patients with locally advanced esophageal squamous cell carcinoma in the era of intensity modulated radiotherapy: a propensity score-matched analysis

Chen Li, Lijun Tan, Xiao Liu, Xin Wang, Zongmei Zhou, Dongfu Chen, Qinfu Feng, Jun Liang, Jima Lv, Xiaozhen Wang, Nan Bi, Lei Deng, Wenqing Wang, Tao Zhang, Wenjie Ni, Xiao Chang, Weiming Han, Linrui Gao, Shijia Wang, Zefen Xiao, Chen Li, Lijun Tan, Xiao Liu, Xin Wang, Zongmei Zhou, Dongfu Chen, Qinfu Feng, Jun Liang, Jima Lv, Xiaozhen Wang, Nan Bi, Lei Deng, Wenqing Wang, Tao Zhang, Wenjie Ni, Xiao Chang, Weiming Han, Linrui Gao, Shijia Wang, Zefen Xiao

Abstract

Background: To investigate the survival benefit of concurrent chemoradiotherapy (CCRT) for patients with locally advanced esophageal squamous cell carcinoma (ESCC) during the years of intensity-modulated radiotherapy (IMRT).

Methods: Medical records of 1089 patients with ESCC who received IMRT from January 2005 to December 2017 were retrospectively reviewed. A total of 617 patients received CCRT, 472 patients received radiotherapy (RT) alone. Propensity score matching (PSM) method was used to eliminate baseline differences between the two groups. Survival and toxicity profile were evaluated afterward.

Results: After a median follow-up time of 47.9 months (3.2-149.8 months), both overall survival (OS) and progression-free survival (PFS) of the CCRT group were better than those of the RT alone group, either before or after PSM. After PSM, the 1-, 3-, and 5-year OS of RT alone and CCRT groups were 59.0% versus 70.2%, 27.7% versus 40.5% and 20.3% versus 33.1%, respectively (p < 0.001). The 1-, 3-, and 5-year PFS were 39.4% versus 49.0%, 18.3% versus 30.4% and 10.5% versus 25.0%, respectively (p < 0.001). The rates of ≥ grade 3 leukopenia and radiation esophagitis in the CCRT group were higher than that of RT alone group (p < 0.05). There was no significant difference in the probability of radiation pneumonitis between the two groups (p = 0.167). Multivariate Cox analysis indicated that female, EQD2 ≥60 Gy and concurrent chemotherapy were favorable prognostic factors for both OS and PFS.

Conclusions: Concurrent chemotherapy can bring survival benefits to patients with locally advanced ESCC receiving IMRT. For patients who cannot tolerate concurrent chemotherapy, RT alone is an effective alternative with promising results.

Keywords: concurrent chemoradiotherapy; esophageal cancer; intensity-modulated radiotherapy; propensity score.

Conflict of interest statement

No authors report any conflict of interest.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Figures

FIGURE 1
FIGURE 1
CONSORT diagram showing patient selection. CCRT, concurrent chemoradiotherapy; PSM, propensity score matching; RT, radiotherapy
FIGURE 2
FIGURE 2
OS and PFS of patients receiving RT and CCRT both before and after PSM. Kaplan–Meier (KM) estimates of (a) OS before PSM, with 95% CIs. (b) OS after PSM, with 95% CIs. (c) PFS before PSM, with 95% CIs. (d) PFS after PSM, with 95% CIs. Blue curve represents survival in the RT alone group; red curve, survival in the CCRT group
FIGURE 3
FIGURE 3
Subgroup analysis of patients receiving RT and CCRT in the after‐PSM sample. Kaplan–Meier (KM) estimates of OS of (a) elderly patients (≥70 years old). (b) Non‐elderly patients (

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