Abstract
For patients with neck and upper thoracic esophageal carcinoma, it is difficult to control lymph node metastases with conventional dose therapy. In this study, we assessed the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes.Three radiation treatment volumes were defined: PGTVnd, with which 68.1 Gy was delivered in high dose group (hsIMRT group), and 60 Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9 Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54 Gy given to both groups. The sIMRT plan included 5 equi-angular coplanar beams. All patients received the cisplatin and 5-FU regimen concurrently with radiotherapy. The treatment was completed within six weeks and one case with grade three acute bronchitis was observed in hsIMRT group. For esophageal lesions, 80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P <0.05). The differences in 1-, 2- and 3-year relapse-free survival rates were all statistically significant (P <0.05). The major toxicity observed in both groups was Grade I~II leucopenia. sIMRT can generate a desirable dose distribution in treatment of neck and upper thoracic esophageal carcinoma with a better short-term efficacy. Boosted high dosing to metastatic lymph nodes can increase the relapse-free survival rate.
Highlights
Neck or upper thoracic esophageal carcinoma with lymph node metastasis is a common clinical disease with poor prognosis (Kawahara et al, 1998; Kurokawa et al, 2003; Xiao et al 2003; Xiao et al, 2005; Tachimori et al, 2011)
We assessed the feasibility of simplified intensity-modulated radiotherapy and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes.Three radiation treatment volumes were defined: PGTVnd, with which 68.1Gy was delivered in high dose group, and 60Gy in the conventional dose group; PTV1, featuring 63.9Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54Gy given to both groups
80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P
Summary
Neck or upper thoracic esophageal carcinoma with lymph node metastasis is a common clinical disease with poor prognosis (Kawahara et al, 1998; Kurokawa et al, 2003; Xiao et al 2003; Xiao et al, 2005; Tachimori et al, 2011). Metastatic lymph node is difficult to control by radiotherapy with the conventional dose, especially those large metastatic lymph nodes (Watarai et al, 1992). The dose to the tumor and surrounding region (target volume) is heterogeneously delivered due to anatomic changes between neck and upper thorax dimensions, especially with conventional or three-dimensional conformal radiotherapy (Tai et al, 1998; 2000). Intensity modulation radiation therapy (IMRT) is a technique using a multi leaf collimator (MLC) to form multiple segments for step-and-shoot. Though IMRT can solve the problem of target dose distribution, it results in the prolongation of time of therapy due to the large number of segments and a small area of each segment, which, is apt to cause great dose errors via the locomotion of bodily organs. Apart from that, for each patient undergoing IMRT, correct dose should be verified, which inevitably takes up a lot of manpower and material resources
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