We aimed to analyze the clinical efficacy and treatment-related complications in patients with T_4b esophageal squamous cell carcinoma (SCC) who received concurrent CRT, and to explore the potential prognostic factors related to survival.

Between 2010 and 2015, 143 patients with T_4b esophageal SCC treated with CRT were analyzed, including 71% patients with trachea and/or bronchus invasion and 44% patients with aorta and/or large vessel invasion. The median radiation dose was 60 Gy (range, 44-68 Gy) with conventional fractionation, including 69 patients (48%) treated with three-dimensional conformal radiotherapy and 74 patients (52%) treated with intensity-modulated radiotherapy. All patients received concurrent platinum-based chemotherapy during radiotherapy. Kaplan-Meier method was used to analyze the survival, the log-rank test was used to examine group differences, and the Cox regression model was used for multivariate analysis.

The median overall survival (OS) time for the whole cohort was 12.2 months. The 2-and 3-year OS rates were 34% and 29%, respectively. A total of 51 patients experienced ≥2 severe non-hematological complications, including 42 esophageal fistula, 6 pneumonia, and 3 esophageal hemorrhage. Patients with severe complications showed significantly worse survival than those without complications (6.9 months vs.20.4 months, P<0.01). Multivariate analysis revealed that TNM stage and severe complications were independent prognostic factors for OS.

Patients with T_4b esophageal SCC who received CRT showed satisfactory survival but with high risk of severe complications. Therefore, prevention and treatment of severe complications is the key to improve efficacy.

Esophageal neoplasms/chemoradiotherapy; Prognosis