Phase 2 Study of Intensity Modulated Radiation With Concurrent Chemotherapy as Definitive Treatment for Esophageal Squamous Cell Cancer

Abstract

Purpose/Objective(s)To explore the feasibility and therapeutic effect of simultaneous integrated boost intensity modulated radiation (SIB-IMRT) and concurrent systemic chemotherapy as definitive treatment for esophageal squamous cell cancer.Materials/MethodsFrom May 2009 through December 2011, 22 patients with histologically proven esophageal squamous cell cancer who were treated with intensity modulated radiation therapy were analyzed (4 cervical esophageal cancer, 11 upper thoracic esophageal cancer, 7 in the middle). The tumor lengths in long axis measured in barium esophagogram were from 2.5cm to 10cm (median: 5cm). Six patients presented with stage±disease, nine patients with stage II disease, and seven patients with stage III disease. The esophageal tumor visible in CT image and positive regional lymph nodes (LN) were contoured as the gross target volume (GTV) for each patient. Three cm longitudinal and 1.0cm radial margins were added to the esophagus GTV and LN region with positive LN to form the clinical target volume (CTV). Then two planning target volumes were formed: FPTV was GTV+0.5cm; PTV-c was CTV+0.5cm. The prescribed dose was 60-66 Gy/28-30f to PTV and 50.4 -54Gy/28-30f to PTV-c. Concurrent systemic therapy was scheduled with DP regimen (Docetaxel 75mg/kg d1 and cisplatin 60mg d1, 2) in all patients from the beginning of the radiation therapy. Locoregional control and overall survival as well as acute and late toxicities were evaluated.ResultsA radiation therapy plan was completed for all patients except 1. Short-term effects were: 7 patients getting CR (33.3%), 10 patients getting PR (47.6%), 4 patients getting SD (19%). Effective rate was 66.7%. The median overall survival was 26 months. The actuarial 1, 2, 3, and 5-year overall survival rates were 95.2%, 52.4%, 23.8% and 9.5%, respectively. For the patients getting CR, the median survival was 31 months, 2-year, and 3-year survival rates were 85.7% and 57.1%, respectively. For the patients getting PR, the median survival was 19 months, 2-year, and 3-year survival rates were 40% and 10%, respectively. For the patients getting SD, the median survival was 14 months, 2-year, and 3-year survival rates were 25% and 0, respectively. Six patients (28.6%) suffered from acute CTC grade 3/4 toxicity of hematological side effects, and 4 patients (19%) suffered from acute CTC grade 3/4 toxicity of radiation-induced esophagus. No severe side effects to lung, heart, and skin were observed. Esophagus fistula occurred in 3 patients within one year after treatment and the occurrence rate was 14.3%.ConclusionIntensity modulated RT with an integrated boost to gross tumor with concurrent systemic chemotherapy is feasible and effective in the definitive treatment for esophageal cancer. Acute toxicities could be tolerated and accepted by the patients. Purpose/Objective(s)To explore the feasibility and therapeutic effect of simultaneous integrated boost intensity modulated radiation (SIB-IMRT) and concurrent systemic chemotherapy as definitive treatment for esophageal squamous cell cancer. To explore the feasibility and therapeutic effect of simultaneous integrated boost intensity modulated radiation (SIB-IMRT) and concurrent systemic chemotherapy as definitive treatment for esophageal squamous cell cancer. Materials/MethodsFrom May 2009 through December 2011, 22 patients with histologically proven esophageal squamous cell cancer who were treated with intensity modulated radiation therapy were analyzed (4 cervical esophageal cancer, 11 upper thoracic esophageal cancer, 7 in the middle). The tumor lengths in long axis measured in barium esophagogram were from 2.5cm to 10cm (median: 5cm). Six patients presented with stage±disease, nine patients with stage II disease, and seven patients with stage III disease. The esophageal tumor visible in CT image and positive regional lymph nodes (LN) were contoured as the gross target volume (GTV) for each patient. Three cm longitudinal and 1.0cm radial margins were added to the esophagus GTV and LN region with positive LN to form the clinical target volume (CTV). Then two planning target volumes were formed: FPTV was GTV+0.5cm; PTV-c was CTV+0.5cm. The prescribed dose was 60-66 Gy/28-30f to PTV and 50.4 -54Gy/28-30f to PTV-c. Concurrent systemic therapy was scheduled with DP regimen (Docetaxel 75mg/kg d1 and cisplatin 60mg d1, 2) in all patients from the beginning of the radiation therapy. Locoregional control and overall survival as well as acute and late toxicities were evaluated. From May 2009 through December 2011, 22 patients with histologically proven esophageal squamous cell cancer who were treated with intensity modulated radiation therapy were analyzed (4 cervical esophageal cancer, 11 upper thoracic esophageal cancer, 7 in the middle). The tumor lengths in long axis measured in barium esophagogram were from 2.5cm to 10cm (median: 5cm). Six patients presented with stage±disease, nine patients with stage II disease, and seven patients with stage III disease. The esophageal tumor visible in CT image and positive regional lymph nodes (LN) were contoured as the gross target volume (GTV) for each patient. Three cm longitudinal and 1.0cm radial margins were added to the esophagus GTV and LN region with positive LN to form the clinical target volume (CTV). Then two planning target volumes were formed: FPTV was GTV+0.5cm; PTV-c was CTV+0.5cm. The prescribed dose was 60-66 Gy/28-30f to PTV and 50.4 -54Gy/28-30f to PTV-c. Concurrent systemic therapy was scheduled with DP regimen (Docetaxel 75mg/kg d1 and cisplatin 60mg d1, 2) in all patients from the beginning of the radiation therapy. Locoregional control and overall survival as well as acute and late toxicities were evaluated. ResultsA radiation therapy plan was completed for all patients except 1. Short-term effects were: 7 patients getting CR (33.3%), 10 patients getting PR (47.6%), 4 patients getting SD (19%). Effective rate was 66.7%. The median overall survival was 26 months. The actuarial 1, 2, 3, and 5-year overall survival rates were 95.2%, 52.4%, 23.8% and 9.5%, respectively. For the patients getting CR, the median survival was 31 months, 2-year, and 3-year survival rates were 85.7% and 57.1%, respectively. For the patients getting PR, the median survival was 19 months, 2-year, and 3-year survival rates were 40% and 10%, respectively. For the patients getting SD, the median survival was 14 months, 2-year, and 3-year survival rates were 25% and 0, respectively. Six patients (28.6%) suffered from acute CTC grade 3/4 toxicity of hematological side effects, and 4 patients (19%) suffered from acute CTC grade 3/4 toxicity of radiation-induced esophagus. No severe side effects to lung, heart, and skin were observed. Esophagus fistula occurred in 3 patients within one year after treatment and the occurrence rate was 14.3%. A radiation therapy plan was completed for all patients except 1. Short-term effects were: 7 patients getting CR (33.3%), 10 patients getting PR (47.6%), 4 patients getting SD (19%). Effective rate was 66.7%. The median overall survival was 26 months. The actuarial 1, 2, 3, and 5-year overall survival rates were 95.2%, 52.4%, 23.8% and 9.5%, respectively. For the patients getting CR, the median survival was 31 months, 2-year, and 3-year survival rates were 85.7% and 57.1%, respectively. For the patients getting PR, the median survival was 19 months, 2-year, and 3-year survival rates were 40% and 10%, respectively. For the patients getting SD, the median survival was 14 months, 2-year, and 3-year survival rates were 25% and 0, respectively. Six patients (28.6%) suffered from acute CTC grade 3/4 toxicity of hematological side effects, and 4 patients (19%) suffered from acute CTC grade 3/4 toxicity of radiation-induced esophagus. No severe side effects to lung, heart, and skin were observed. Esophagus fistula occurred in 3 patients within one year after treatment and the occurrence rate was 14.3%. ConclusionIntensity modulated RT with an integrated boost to gross tumor with concurrent systemic chemotherapy is feasible and effective in the definitive treatment for esophageal cancer. Acute toxicities could be tolerated and accepted by the patients. Intensity modulated RT with an integrated boost to gross tumor with concurrent systemic chemotherapy is feasible and effective in the definitive treatment for esophageal cancer. Acute toxicities could be tolerated and accepted by the patients.