Long-term efficacy of 159 cases of cervical and upper esophageal carcinoma treated with intensity-modulated radiotherapy

Objective: To evaluate the long-term efficacy and related prognostic factors of cervical and upper esophageal carcinoma treated with intensity-modulated radiotherapy (IMRT). Methods: From January 2006 to August 2012, 159 patients of cervical and upper esophageal squamous cell carcinoma treated with IMRT were analyzed retrospectively. The acute side effect and failure modes of treatment were observed, and l-, 3- and 5-year local control rates, survival rates, and prognostic factors were analyzed. Results: The follow-up rate of patients was 99.4%. The number of patients who completed the 1-, 3- and 5-year follow-up were 159, 150 and 57, respectively. The overall remission rate was 95.6%. The 1-, 3- and 5-year local control rates were 72.3%, 56.6% and 52.1%, respectively. The 1-, 3- and 5-year survival rates were 82.4%, 47.0% and 34.8%, respectively. The median survival time was 31 months. The 1-, 3- and 5-year local control rates and survival rates were 85.4%, 62.5%, 53.7% and 83.3%, 55.4%, 33.3% for cervical esophageal carcinoma, 68.6%, 55.2%, 52.2% and 81.3%, 44.6%, 35.7% for upper esophageal carcinoma. There were no significant differences in the local control rates and overall survival rates between the cervical esophageal carcinoma and upper esophageal carcinoma groups (P > 0.05). Both univariate analysis and multivariate analysis showed that gross tumor volume (GTV) and short term effect were the prognostic factors (χ² = 19.407, 35.489, P < 0.05). Grade 1 and 2 acute pneumonitis incidence rates were 13.2% and 5.7%, respectively. Grade 1, 2 and 3 acute esophagitis incidence rates were 54.7%, 8.8% and 3.3%, respectively. The local failure accounted for 61.1% of all treatment-related failures. Conclusions: IMRT is safe and effective in the treatment of cervical and upper esophageal carcinoma. The GTV size and tumor response after radiotherapy are independent prognostic factors for survival. Local failure is still the main reason of treatment failures. (authors)