Comparison of Simultaneous Integrated Boost and Late-course Boost Intensity-modulated Radiation Therapy in the Treatment of Esophageal Carcinoma

Abstract This paper aimed to analyze and compare the outcomes of esophageal carcinoma treated with simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) and late-course boost intensity-modulated radiation therapy (LCB-IMRT). The retrospective study was designed to analyze the clinical data of 274 esophageal cancer patients who received radical radiotherapy in the Oncology Department of our hospital, from January 2014 to December 2017. Propensity score matching analysis was used to balance the variable differences in the two groups. Survival, toxicities, and target dose were observed and compared between the two groups. Statistical analysis was performed using SPSS 24.0 software. P<0.05 judged to be statistically significant. 200 patients were finally included after propensity scores matching , The 1-, 3-, and 5-year overall survival and local control rates of the entire group were 80.5% vs. 67.6%, 38.2% vs. 31.3%，and 22.2% vs. 20.4%, respectively. The 1-, 3-, and 5-year overall survival rates of the SIB-IMRT and LCB-IMRT group were 85.0% vs. 76.0%, 41.8% vs. 34.5%, and 25.5% vs. 21.3%, respectively (P＞0.05). The 1-, 3-, and 5- year local control rates of the SIB-IMRT and LCB-IMRT group were 77.3% vs. 58.0%, 31.4% vs. 30.1%, and 20.0% vs. 20.7%, respectively (P＞0.05). The recent total effective rates of the SIB-IMRT and LCB-IMRT group were 96.0% vs. 92.0% ( P ＞0.05). There were statistically significant differences in the incidence of ≥2 grade acute radiation esophagitis and pneumonia between the two groups ( P ＜0.05). The does of lung V5, lung V10, lung Dmean, and spinal cord Dmax in the SIB-IMRT group were significantly lower than those in LCB-IMRT group ( P ＜0.05). Patients age, tumor location, tumor length, gross tumor target volume, N stage were independent prognostic factors of overall survival and local control. Compared with the LCB-IMRT group, the survival prognosis of the SIB-IMRT group has benefit trend, patients in the SIB-IMRT group received less radiation dose to the normal organs around the target area, and the toxicities effects of radiotherapy were lighter, which is more conducive to the protection of normal tissues around the target area.