Outcomes of chemoradiotherapy with a high irradiation dose using a 3D radiation treatment planning system for esophageal cancer.

Abstract

89 Background: The standard irradiation dose of chemoradiotherapy (CRT) for esophageal cancer is 50.4 Gy, however, the trials in which this standard dose was originated were based on 2D radiation treatment planning. In this study we assessed the survival and toxicities of CRT with a dose of 60-66 Gy using a 3D radiation treatment planning system (3DRTPS) for esophageal cancer. Methods: One hundred and two eligible patients with esophageal cancer treated by definitive CRT between 2000 and 2006 were assessed. Median age was 67 years old. There were stage I in 22 patients, stage II-III (without T4) in 27 and T4/M1Lymph legions in 53. There were 100 patients with squamous cell carcinoma histology and 2 with small cell carcinoma. Main tumor sites were cervical/upper/middle/lower thoracic in 15/19/43/25 patients. Treatment planning of irradiation was performed using a CT based 3DRTPS. Total irradiation dose of our protocol was 60-66 Gy. Accomplishment rate of planned irradiation was 93%. All patients received chemotherapy concurrently with radiotherapy. Fluorouracil based chemotherapy was performed in 96 patients (94%). Results: The data was updated in August 2010. The median follow-up was 67 months. Cause-specific survival rates at 5 years for stage I, II-III (without T4) and T4/M1lymph were 100%, 49% and 17%, respectively and overall survival rates were 66%, 35% and 13%, respectively. Complete response (CR) rates were 100%, 79% and 35%, respectively and failure rates of CR cases were 5%, 43% and 42%, respectively. Late adverse effects (≥ grade 3) were observed in 11 patients (10%); pneumonitis in 4 (4%), pleural effusion in 4 (4%) and pericardial effusion in 5 (5%). Treatment related deaths were observed in 2 cases (pneumonitis developed during treatment in 1 and debility due to treatment in 1). Conclusions: Toxicities of CRT with a high irradiation dose using 3DRTPS for esophageal cancer were acceptable and survival was promising. Dose intensification study of 50.4 Gy versus ≥ 60 Gy in CRT using a 3D-conformal radiation therapy technique for esophageal cancer should be considered. No significant financial relationships to disclose.