Abstract
BackgroundWe compared the efficacy, safety, and costs of hypofractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) for the neoadjuvant treatment of esophageal cancer.Materials and MethodsOverall, 110 patients with esophageal cancer treated with neoadjuvant chemoradiotherapy from October 2002 to July 2017 were retrospectively included and divided into a HFRT group (42 patients received 30 Gray [Gy]/10 fractions for 2 weeks) and a CFRT group [68 patients received 40 Gy/20 fractions for 4 weeks]. Concurrent chemotherapy comprised cisplatin combined with either 5‐FU or taxane. Surgery was performed 3‐8 weeks after radiotherapy. We compared the outcomes, adverse events, and costs between the two groups.ResultsPathological downstaging was achieved in 78.6% of the HFRT group and 83.8% of the CFRT group (P = 0.612). Compared with the CFRT group, the HFRT group had similar pathological complete response (pCR) (33.3% vs 35.3%; P = 0.834), median overall survival (OS) (40.8 months vs 44.9 months; P = 0.772) and progression free survival (32.7 months vs 35.4 months; P = 0.785). The perioperative complication rates were also similar between the groups, but the treatment time and costs were significantly reduced in the HFRT group (P < 0.05). Finally, multivariate analysis identified cN0 stage, pathological downstaging and pCR as independent predictors of better OS.ConclusionPreoperative HFRT is effective and safe for esophageal cancer. Moreover, it is similar to CFRT in terms of overall survival and toxicity and is cost effective and less time consuming.
Highlights
Neoadjuvant chemoradiotherapy has become a promising treatment for patients with stage II or III esophageal cancer
We retrospectively reviewed 110 patients with esophageal cancer who were treated with neoadjuvant chemoradiotherapy followed by surgery at authors, institute from October 2002 to July 2017
On comparing the time commitments and costs related to therapy, we found that preoperative hypofractionated radiotherapy (HFRT) can significantly shorten the durations of both radiotherapy and hospitalization (16.7 and 69.0 days, respectively) compared with conventional fractionated radiotherapy (CFRT) (32.8 and 80.4 days, respectively) by requiring fewer fractions
Summary
Neoadjuvant chemoradiotherapy has become a promising treatment for patients with stage II or III esophageal cancer. Conventional fractionated radiotherapy (CFRT) is the most commonly used neoadjuvant option for esophageal cancer, but the efficacy and safety of preoperative hypofractionated radiotherapy (HFRT), which delivers a dose larger than 2 Gray (Gy) per fraction in a lower overall dose, has been studied in some patients with esophageal cancer.[4,5]. These studies have indicated that preoperative HFRT could improve the local control rate of esophageal cancer and potentially increase patient survival compared with surgery alone. This retrospective study aimed to investigate and compare the efficacy, safety, and costs of neoadjuvant HFRT and the standard CFRT regimen for esophageal cancer
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