Abstract
BackgroundLocoregional recurrence is a major problem in esophageal cancer patients treated with definitive concomitant chemoradiotherapy. Approximately half of the patients fail locoregionally. We analyzed the impact of enlarged radiation field size and higher radiation dose incorporated to chemoradiotherapy on oncologic outcome.MethodsSeventy-four consecutive patients with histologically proven nonmetastatic squamous or adenocarcinoma of the esophagus were included in this retrospective analysis. All patients were locally advanced cT3–T4 and/or cN0-1. Treatment consisted of either definitive concomitant chemoradiotherapy (Def-CRT) (n = 49, 66 %) or preoperative concomitant chemoradiotherapy (Pre-CRT) followed by surgical resection (n = 25, 34 %). Patients were treated with longer radiation fields. Clinical target volume (CTV) was obtained by giving 8–10 cm margins to the craniocaudal borders of gross tumor volume (GTV) instead of 4–5 cm globally accepted margins, and some patients in Def-CRT group received radiation doses higher than 50 Gy.ResultsIsolated locoregional recurrences were observed in 9 out of 49 patients (18 %) in the Def-CRT group and in 1 out of 25 patients (3.8 %) in the Pre-CRT group (p = 0.15). The 5-year survival rate was 59 % in the Def-CRT group and 50 % in the Pre-CRT group (p = 0.72). Radiation dose was important in the Def-CRT group. Patients treated with >50 Gy (11 out of 49 patients) had better survival with respect to patients treated with 50 Gy (38 out of 49 patients). Five-year survivals were 91 and 50 %, respectively (p = 0.013).ConclusionsRadiation treatment planning by enlarged radiation fields in esophageal cancer decreases locoregional recurrences considerably with respect to the results reported in the literature by standard radiation fields (18 vs >50 %). Radiation dose is as important as radiation field size; patients in the Def-CRT group treated with ≥50 Gy had better survival in comparison to patients treated with 50 Gy.
Highlights
Locoregional recurrence is a major problem in esophageal cancer patients treated with definitive concomitant chemoradiotherapy
The aim of this study is to analyze our patient experience with locally advanced esophageal carcinoma who underwent either surgery following preoperative chemoradiotherapy (Pre-CRT) or definitive concomitant chemoradiotherapy (Def-CRT) using longer radiation fields at craniocaudal borders of gross tumor volume (GTV) and higher radiation doses and the outcome of these treatment parameters in terms of locoregional recurrence and survival
Tumor stage was evaluated by physical examination, neck, thoracic, and abdominal computerized tomography (CT), upper gastrointestinal endoscopy, and, after 2008, by fluorodeoxyglucose positron emission tomography (PET-CT) (n = 27, 36 %)
Summary
Locoregional recurrence is a major problem in esophageal cancer patients treated with definitive concomitant chemoradiotherapy. Locoregional recurrence is a major concern and the primary mode of failure in esophageal cancer patients treated either with surgery or definitive chemoradiotherapy. Longitudinal interconnecting system of lymphatics facilitates early lympathic spread of the tumors and potential risk for lymphatic involvement. Lymph node metastases can be observed even with superficial esophageal tumors. Autopsy findings demonstrate residual or recurrent tumor in 60 % of the patients after curative surgery. While local recurrences were observed in 25.6 % of autopsied cases, lymph node metastases were observed in 41.9 % of the cases [11]
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