Abstract
PurposeWe aimed to evaluate the long-term outcomes of concurrent chemoradiotherapy (CCRT) with a simultaneous integrated boost (SIB) of radiotherapy for esophageal squamous cell carcinoma (ESCC).Methods and MaterialsEighty-seven patients with primary ESCC enrolled in this phase II trial. The majority (92.0%) had locoregionally advanced disease. They underwent definitive chemoradiotherapy. The radiotherapy doses were 66 Gy for the gross tumor and 54 Gy for the subclinical disease. Doses were simultaneously administered in 30 fractions over 6 weeks. The patients also underwent concurrent and adjuvant chemotherapy, which comprised cisplatin and fluorouracil. The study end points were acute and late toxicities, first site of failure, locoregional tumor control, and overall survival rates.ResultsThe median follow-up time was 65.7 (range, 2.2-97.5) months for all patients and 81.5 (range, 19.4-97.5) months for those alive. There were 17 cases (19.5%) of severe late toxicities, including four cases (4.6%) of grade 5 and seven (8.0%) of grade 3 esophageal ulceration, four (4.6%) of grade 3 esophageal stricture, and two (2.3%) of grade 3 radiation-induced pneumonia. Twenty-three (26.4%) patients had locoregional disease progression. Most (86.7%) locally progressive lesions were within the dose-escalation region in the initial radiation plan, while majority of the recurrent lymph nodes were found out-of-field (83.3%) and in the supraclavicular region (75.0%). The 1-, 2-, 3-, and 5-year locoregional tumor control and overall survival rates were 79.2%, 72.4%, 72.4%, 70.8%, and 82.8%, 66.6%, 61.9%, 58.4%, respectively. Incomplete tumor response, which was assessed immediately after CCRT was an independent risk predictor of disease progression and death in ESCC patients.ConclusionsCCRT with SIB was well tolerated in ESCC patients during treatment and long-term follow-up. Moreover, patients who underwent CCRT with SIB exhibited improved local tumor control and had better survival outcomes compared to historical data of those who had standard-dose radiotherapy.
Highlights
Esophageal cancer (EC) is the sixth leading cause of cancerrelated deaths worldwide [1]
In a multicenter retrospective data analysis of 2132 patients reported by Wang et al, the results showed the incidence of late toxicity in SIB group were significantly lower than No-SIB group [40].These results suggested that SIB-IMRT in combination with concurrent chemotherapy was tolerable in EC patients
Most locally progressive lesions were found within the PTV66, while local disease progression was the main death reason of this cohort of patients
Summary
Esophageal cancer (EC) is the sixth leading cause of cancerrelated deaths worldwide [1]. Concurrent chemoradiotherapy (CCRT) has been established as the standard treatment for locally advanced EC since the 1990s [2, 3]. It consists of a total dose of 50.4 Gray (Gy) irradiation given in conventional fractionation to both the gross tumor and the subclinical disease with concurrently cisplatin-based chemotherapy. Administration of a brachytherapy boost after external-beam radiotherapy (EBRT) did not improve survival in patients with EC. It was associated with an increased incidence of esophageal fistula [6, 7]. The current non-surgical standard treatment for EC remains to be CCRT with a total radiation dose of 50.4 Gy in conventional fractionation. Local recurrence within the GTV remains to be the most common failure after treatment
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