Comparison of the effects of radiotherapy doses of 50.4\xa0Gy and 60\xa0Gy on outcomes of chemoradiotherapy for thoracic esophageal cancer: subgroup analysis based on the Comprehensive Registry of Esophageal Cancer in Japan from 2009 to 2011 by the Japan Esophageal Society

Kenji Nemoto,Shohei Kawashiro,Keiichi Jingu,Hisahiro Matsubara,Yasushi Toh,Hodaka Numasaki,Takashi Uno,Yuji Tachimori

doi:10.1007/s10388-019-00711-x

Abstract

BackgroundIn definitive chemoradiotherapy (CRTx) for esophageal cancer, a radiotherapy (RT) dose of 50.4 Gy in 28 fractions has been the standard in many countries, while 60 Gy in 30 fractions has been frequently used in Japan. To clarify the optimal RT dose in CRTx for esophageal cancer, we compared clinical outcomes with the two doses using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES).MethodsOf the patients enrolled in the registry for 2015–2017 surveys (patients treated between 2009 and 2011), 996 patients who received definitive CRTx with 50.4 Gy or 60 Gy for thoracic esophageal cancer were eligible for analysis.ResultsThe complete response (CR) rates in the 50.4 Gy and 60 Gy groups were 49.1% and 46.4%, respectively (p = 0.5851). The 5-year overall survival (OS) rates in the 50.4 Gy group and 60 Gy group for stages I, II/III and IV were 64.2% and 57.2%, 35.0% and 27.0%, and 18.0% and 15.3%, respectively. Since no significant difference was found between the two groups, the 50.4 Gy group was not inferior to the 60 Gy group with regard to OS.ConclusionsThe analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan.

Highlights

Chemoradiotherapy (CRTx) has been the standard of care for patients with esophageal cancer who are not candidates for resection due to medically inoperable patients, unresectable locally advanced disease or refusal to undergo surgery
We compared the clinical outcomes of CRTx with RT doses of 50.4 Gy and 60 Gy using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES) to clarify the optimal RT dose in CRTx for esophageal cancer
A larger proportion of patients in the 60 Gy group had a primary tumor at the middle thoracic esophagus, while the proportion of patients with a primary tumor at the lower thoracic esophagus was larger in the 50.4 Gy group (p = 0.0133)

Summary

Introduction

Chemoradiotherapy (CRTx) has been the standard of care for patients with esophageal cancer who are not candidates for resection due to medically inoperable patients, unresectable locally advanced disease or refusal to undergo surgery. In CRTx for esophageal cancer, a radiation therapy (RT) dose of 50.4 Gy in 28 fractions has been the global standard based on results of the INT 0123 phase III trial [4]. We compared the clinical outcomes of CRTx with RT doses of 50.4 Gy and 60 Gy using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES) to clarify the optimal RT dose in CRTx for esophageal cancer. Conclusions The analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan

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Results

Discussion

Conclusion