Comparative study between elective nodal irradiation and involved field radiation therapy for early-stage esophageal carcinoma

OBJECTIVE: To analyze the feasibility of elective nodal irradiation for early-stage esophageal carcinoma, evaluate the curative effect of radiation therapy, and determine the causes of treatment failure. MATERIALS AND METHODS: Data were collected from 123 patients with esophageal cancer T1-2 N0-1 M0 stage. Patients were divided into two groups based on different types of radiotherapy. Among the 123 patients, 102 underwent involved field radiotherapy, whereas 21 received elective nodal irradiation. A comparative analysis of patients in the two groups was conducted. RESULTS: In 123 patients, the one-, three-, and five-year overall survival rates were 87.8%, 47.2%, and 36.6%, respectively. By contrast, the one-, three-, and five-year local control rates were 89.4%, 67.5%, and 48.8%, respectively. After comparing the one-, three-, and five-year survival rates in the elective nodal irradiation patients (90.5%, 47.6%, and 42.9%, respectively) with those in the involved field radiotherapy patients (86.3%, 49.0%, and 35.2%, respectively), no significant difference was found (Chi2=0.290, p=0.588). The results indicate that elective nodal irradiation possibly decreased nodal metastases (Chi2=5.778, p=0.016). CONCLUSION: Three-dimensional conformal radiotherapy is one of the best therapeutic regimens of radiation for esophageal cancer. Elective nodal irradiation is possibly effective for preventing regional nodal metastasis. Whether elective nodal irradiation leads to an improved overall survival needs further investigation.