Abstract
Background and PurposeWe compared treatment outcomes and toxicities of photon radiotherapy versus proton beam therapy (PBT) and evaluated radiation field effects for T1–3 squamous cell carcinoma of the thoracic esophagus (EC) without lymph node metastasis.MethodsMedical records of 77 patients with T1–3N0M0 thoracic EC treated with radiotherapy between 2011 and 2019 were retrospectively analyzed. Among these patients, 61 (79.2%) individuals had T1 EC. The initial clinical target volume encompassed the whole esophagus with or without supraclavicular and/or abdominal lymph nodes (extended-field radiotherapy; 67 patients, 87.0%) or the area 3–5 cm craniocaudally and 1–2 cm radially from the gross tumor volume (involved-field radiotherapy; 10 patients, 13.0%). The final clinical target volume included margins of at least 1 cm from the gross tumor volume, with total radiation doses of 50–66 (median, 66) cobalt gray equivalent. Three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and PBT were used in twenty-four, five, and forty-eight patients, respectively. Concurrent chemotherapy was administered to 17 (22.0%) patients overall and only five (8.0%) T1 patients.ResultsPBT showed significantly lower lung and heart radiation exposure in mean dose, V5, V10, V20, and V30 than photon radiotherapy. The median follow-up for all patients was 46 (interquartile range, 22–72) months. The 5-year progression-free survival and overall survival rates were 56.5 and 64.9%, respectively, with no significant survival difference between photon radiotherapy and PBT. In patients with T1 EC, 5-year progression-free survival and overall survival rates were 62.6 and 73.5%, respectively.ConclusionsExtended-field radiotherapy using modern radiotherapy techniques without chemotherapy showed satisfactory clinical outcomes for lymph node-negative T1 EC.
Highlights
The esophagus has abundant and complex lymphatic channels that begin from the submucosal layer and the outer layers differently communicating intramurally and extramurally [1]
The tumors were in the upper, mid, and lower thoracic esophagus in seven (9.1%), 34 (44.2%), and 36 (46.7%) patients, respectively
Among the patients treated with esophagectomy due to local recurrence, one case of postoperative mortality was observed in the photon RT group, whereas all seven patients treated with proton beam therapy (PBT) successfully underwent salvage esophagectomy without serious postoperative morbidity
Summary
The esophagus has abundant and complex lymphatic channels that begin from the submucosal layer and the outer layers differently communicating intramurally and extramurally [1]. Lymph node (LN) metastasis frequently develops after treatment of esophageal cancer (EC), even in clinically LNnegative T1 superficial EC. Surgery for thoracic EC frequently requires a meticulous LN dissection encompassing the cervico-thoracic-abdominal area in addition to subtotal or total esophagectomy. This extensive surgical procedure for EC can result in a postoperative mortality rate of 0–7% [4,5,6], and complications include laryngeal nerve palsy and gastrointestinal dysfunction [7, 8]. We compared treatment outcomes and toxicities of photon radiotherapy versus proton beam therapy (PBT) and evaluated radiation field effects for T1– 3 squamous cell carcinoma of the thoracic esophagus (EC) without lymph node metastasis
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