Improved survival with higher radiation dose for esophageal squamous cell carcinoma patients treated with definitive chemoradiotherapy.

Yuxia Deng,Hua Tao,Chao Bian,Haijun Zhang

doi:10.18632/oncotarget.19030

Abstract

PurposeThe optimal radiation dose for patients with esophageal squamous cell carcinoma (ESCC) has long been debated. We undertook the retrospective study to evaluate the survival impact of high dose vs standard dose in patients with stage II–III esophageal cancer treated with definitive chemoradiotherapy (CRT).ResultsA total of 137 patients were included in our study, 63 patients classified as standard-dose group and 74 as high-dose group. For the 63 patients in the standard-dose group, the median PFS and the 1-, 2-, and 3-year PFS rates were 12.6 months, 58.0%, 26.0% and 12.0%, respectively; for the 74 patients in the high-dose group, they were 20.0 months, 80.1%, 31.0% and 20.0%, respectively (P = 0.013). The median OS of the patients in the standard-dose group and high-dose group groups were 19.0 months and 26.6 months, respectively, and the 1-, 2- and 3-year survival rates were 78.0%, 39.0%, and 24.0% , and 89.0%, 61.0%, and 30.0%, respectively (P = 0.037). Besides the rate of grade ≥ 3 acute irradiation esophagitis in the high-dose group (10.5% versus. 2.2%, P < 0.01), there were no significantly differ of treatment-related toxicities between the two groups.Materials and MethodsAccording to the radiation dose, patients from 2010 to 2014 were allocated into either the standard-dose group (50–50.4 Gy) or the high-dose group (≥ 59.4 Gy). Overall survival (OS), progression-free survival (PFS) and treatment-related toxicities were assessed and compared between the two groups.ConclusionsOur findings suggest that higher radiation dose could perform better outcomes for esophageal squamous cell carcinoma patients.

Highlights

Esophageal cancer (EC) is a highly lethal malignancy over the world [1, 2]
Besides the rate of grade ≥ 3 acute irradiation esophagitis in the highdose group (10.5% versus. 2.2%, P < 0.01), there were no significantly differ of treatment-related toxicities between the two groups
Our findings suggest that higher radiation dose could perform better outcomes for esophageal squamous cell carcinoma patients

Summary

Introduction

Esophageal cancer (EC) is a highly lethal malignancy over the world [1, 2]. In East Asia, esophageal squamous cell carcinoma (ESCC) is the most common type, whereas adenocarcinoma is predominant in Western countries. [3]. Definitive concurrent chemoradiotherapy (CCRT) is the common strategy for locally advanced inoperable EC patients based on the phase III intergroup trial RTOG 8501, which significantly improved the local control (LC) and overall survival (OS) compared with radiotherapy (RT) alone [5, 6]. On the basis of those clinical trials, 50.4 Gy is recommened as the standard radiation dose for definitive treatment to EC. The outcomes for patients with EC treated by standard dose radical radiotherapy were still disappointing. The optimal radiation dose of definitive CCRT for EC remains in debate. We undertook the retrospective study to analyze the survival prognosis of patients who treated with different radiotherapy dose, and attempted to afford new evidences of choosing optimal radiation dose in EC patients treated with radical CRT

Results

Discussion

Conclusion