Abstract: Objective To investigate the clinical effects， side effects and related factors of prognosis during chemoradiotherapy in patients with advanced esophageal carcinoma. Methods 210 patients with esophageal carcinoma underwent chemoradiotherapy were selected for retrospective analysis. Of the 210 cases， 84 underwent sequential chemoradiotherapy and 126 concurrent chemoradiotherapy. IMRT was implemented at a dose of 60-66 Gy， combined with 2-6 cycles of paclitaxel plus platinum antineoplastic agent chemotherapy for esophageal squamous carcinoma. Response to chemotherapy was assessed by RECIST criteria 1.1 and toxicity was evaluated according to National Cancer Institute Common Toxicity Criteria 30 and acute and chronic radiation injury classification standard of radiation therapy oncology group trial （RTOG）. Follow-up data from radiation therapy and chemotherapy were investigated. Potential prognostic factors were analyzed by univariate analysis and Cox proportional hazard model.
ResultsIn 210 patients, complete response（CR） was observed in 79 patients, partical response（PR） in 99 patients, stable disease（SD） in 21 patients, progressive disease（PD） in 11 patients. The response rate（RR） was 84.8%. The 1， 3year survival rates of the patients with esophageal carcinoma were 79.6％ and 52.2％， respectively. The median survival time was 41.0 months. Concurrent chemoradiotherapy failed to show significant survival advantages than sequential chemoradiotheraphy （P＞0.05）. Univariate analysis showed factors that significantly affected the prognosis included tumor location， N stage， M stage， clinical stage， radiation esophagitis， radiation esophageal stricture and low serum albumin （P＜0.05）. Multivariate analysis revealed that tumor location， N stage， radiation esophageal stricture， and low serum albumin were independent prognostic factors. The main side effects were decreased hemoglobin， radiation esophagitis， radiation esophageal stricture， radiation pneumonitis and hypoproteinemia. The incidence of radiation esophagitis in sequential chemoradiotheraphy was higher than that of concurrent chemoradiotherapy （P＜0.05）. Conclusion Tumor location， N stage， radiation esophageal stricture and low serum albumin are independent prognostic factors in advanced esophageal carcinoma after chemoradiotherapy. Timely treatment of side effects might improve prognosis of esophageal carcinoma.