Abstract
PurposeBecause of the scarcity of cervical esophageal cancer (CEC), data for this disease entity is limited. We aim to evaluate the outcomes, prognostic factors and failure patterns of CEC treated by contemporary radiotherapy (RT).MethodsWe retrospectively analyzed 86 CEC patients consecutively treated between 2007 and 2015 by definitive RT with or without concurrent chemotherapy. RT was mainly delivered with Intensity Modulated Irradiation Therapy (IMRT) or Volumetric-Modulated Arc Therapy (VMAT). Statistical analyses were performed on survival, prognostic factors and failure patterns.ResultsThe median follow-up time was 19.4 months. The 3-year overall survival (OS), local regional failure free survival (LRFFS), distant metastatic free survival (DMFS), and progression free survival (PFS) were 53.6%, 57.9%, 81.5% and 41.5%, respectively. Independent predictors for poorer OS were N stage, hoarseness and recurrent laryngeal nerve lymph node (RLN) involvement, and predictors for LRFFS were N stage and EQD2 (equivalent dose in 2 Gy fraction) to gross tumor volume (GTV), with ≥ 66Gy achieving local control of 94.7%. Patients receiving elective nodal irradiation (ENI) had better nodal regional control than those receiving involved field irradiation (IFI). 31 (36%) patients had treatment failure and 15 (17.4%), 8 (9.3%) and 14 (16.2%) patients had local, regional, and distant failure, respectively. 86.7% (13/15) local failures were within GTV, and supraclavicular region (62.5%, 5/8) was the most common regional failure site. No severe toxicities were observed.ConclusionsOur results seem to indicate that good locoregional control might be achieved for CEC with adequate radiation dose and treatment planning approaches.
Highlights
Squamous cell carcinoma of the cervical esophagus (CEC) is a relatively rare entity, accounting for only 2%– 10% of all esophageal cancers [1]
Our results seem to indicate that good locoregional control might be achieved for CEC with adequate radiation dose and treatment planning approaches
Since there is still no consensus on the optimal RT dose or the extent to which prophylactic treatment of regional nodal basin needs to be included, the current study aims to investigate the outcomes, failure patterns and prognostic factors for CEC patients treated with modern definitive CRT/RT
Summary
Squamous cell carcinoma of the cervical esophagus (CEC) is a relatively rare entity, accounting for only 2%– 10% of all esophageal cancers [1]. Because of the low incidence, the reported data of CEC are rather limited [2]. Due to its anatomical location, CEC often invades adjacent structures, including hypopharynx, thyroid gland, recurrent laryngeal nerves lymph node (RLN) and thoracic esophagus which are poor prognostic features. The optimal treatment approaches using either surgical or non-surgical approach is still controversial [3, 4]. Despite progress made using modern surgical techniques, significant postoperative complications remain, with a negative impact on the patient’s quality of life. Organ-sparing definitive chemoradiotherapy (CRT) is generally recommended for CEC by current consensus guidelines [5,6,7,8]
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