title: Patterns of failure after involved field radiotherapy for locally advanced esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To retrospectively analyze the patterns of failure and the treatment effects of involved-field irradiation (IFI) on patients treated with locally advanced esophageal squamous cell carcinoma (ESCC) and to determine whether IFI is practicable in these patients.
  
  
  METHODS
  A total of 79 patients with locally advanced ESCC underwent three dimensional conformal (3D)CRT) or intensity modulated radiotherapy (IMRT) using IFI or elective nodal irradiation (ENI) according to the target volume. The patterns of failure were defined as local/regional, in-field, out)of)field regional lymph node (LN) and distant failure. With a median follow)up of 32.0 months, failures were observed in 66 (83.6%) patients.
  
  
  RESULTS
  The cumulative incidence of local/regional failure (55.8 vs 52.8%) and in)field regional lymph node failure (25.6 vs 19.4%) showed no statistically significant difference between the IFI and the ENI group (p=0.526 and 0.215, respectively). Out)of)field nodal relapse rate of only 7.0% was seen in the IFI group. Three)year survival rates for the ENI and IFI group were 22.2 and 18.6%, respectively (p=0.240), and 3)year distant metastasis rates were 27.8 and 32.6%, respectively (p=0.180). The lung V10, V20, V30 and mean lung dose of the ENI group were greater than those of the IFI group, while the mean lung dose and V10 had statistically significant difference.
  
  
  CONCLUSIONS
  The patterns of failure and survival rates in the IFI group were similar as in the ENI group; the regional recurrence and distant metastasis are the main cause of treatment failure. IFI is feasible for locally advanced ESCC. Further investigation is needed to increase local control and decrease distant metastasis in these patients.
authors.affiliation: Department of Radiotherapy, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China.
authors.forename: Duo-Jie
authors.initials: DJ
authors.lastname: Li
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Li
authors.forename: Bin
authors.initials: B
authors.lastname: He
authors.forename: Geng-Ming
authors.initials: GM
authors.lastname: Wang
authors.forename: Han-Fei
authors.initials: HF
authors.lastname: Cai
authors.forename: Shi-Miao
authors.initials: SM
authors.lastname: Duan
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Liu
authors.forename: Ya-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Zhen
authors.initials: Z
authors.lastname: Cui
authors.forename: Hao
authors.initials: H
authors.lastname: Jiang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005240:Feasibility Studies; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D002945:Cisplatin; D005472:Fluorouracil