Stage III Esophageal Squamous Cell Carcinoma Patients With Three-Dimensional Conformal or Intensity-Modulated Radiotherapy: A Multicenter Retrospective Study.

Qin Qin,Xiaomin Wang,Junqiang Chen,Wenbin Shen,Chun Han,Xin Wang,Qingsong Pang,Xueying Qiao,Xinchen Sun,Gaofeng Li,Yidian Zhao,Xiaolin Ge,Zefen Xiao,Wencheng Zhang,Chen Li,Shuchai Zhu,Miaomiao Hu,Yati Wang,Miaoling Liu,Ping Wang,Kaixian Zhang,Ling Li,Lan Wang,Zhong Zhou ,Shuo Qie ,Yan Xu ,Chong Hao ,Na Lü

doi:10.3389/fonc.2020.580450

Abstract

Aim: To evaluate long-term outcome and prognostic factors of stage III esophageal cancer after definitive radiotherapy using three dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) techniques.Methods: Patients with T3N1M0/T4N0-1M0 esophageal squamous cell carcinoma (ESCC) treated with definitive radiotherapy from 2002 to 2016 in 10 Chinese medical centers were retrospectively analyzed. Overall survival (OS) and progression-free survival (PFS) rates were calculated. Prognostic factors were analyzed by Log-rank test and multivariable Cox model.Results: Survival data of 1,450 patients were retrospectively collected. With a median follow-up time of 65.9 months, 1-, 3-, and 5-year OS rates were 69.3, 36.7, and 27.7%, respectively, and PFS rates were 58.6, 32.7, and 27.4%, respectively. Univariable analyses showed that gender, age, lesion location, lesion length, largest tumor diameter, lymph node metastasis, gross tumor volume, EQD2, short-term response, and concurrent chemotherapy were prognostic factors for OS. Multivariable analyses showed that lesion location, T-classification, GTV size, EQD2, and short-term response to RT were independent prognostic factors for OS, and tumor diameter, GTV size, and short-term response were independent prognostic factors for PFS.Conclusions: This study demonstrated that definitive radiotherapy using 3DCRT and IMRT provides promising outcomes for locally advanced ESCC.

Highlights

This study demonstrated that definitive radiotherapy using 3DCRT and intensity-modulated radiotherapy (IMRT) provides promising outcomes for locally advanced Esophageal squamous cell carcinoma (ESCC)
Esophageal squamous cell carcinoma (ESCC), a major histopathologic subtype of esophageal cancer, is an aggressive disease with more than 50% of patients diagnosed at the unresectable stage [1]
Italian Association of Radiotherapy and Clinical Oncology (AIRO) has conducted a systematic review to examine efficacy of brachytherapy in esophageal cancer compared with other treatments and found that brachytherapy group had a median dysphagia-free survival (DyFS) of 99 days [9]

Summary

Introduction

Esophageal squamous cell carcinoma (ESCC), a major histopathologic subtype of esophageal cancer, is an aggressive disease with more than 50% of patients diagnosed at the unresectable stage [1]. Definitive chemoradiotherapy (CRT) is recommended as a standard regimen for patients with locally advanced, unresectable esophageal cancer [2, 3]. Intraluminal brachytherapy is recommended for patients unable to tolerate definitive CRT or to alleviate dysphagia in people with advanced esophageal cancer [7]. In addition to palliative aim, brachytherapy can be used for boost after EBRT or reirradiation Because it offers a remarkable dose gradient allowing best organ at risk sparing, with an encouraging rate of long survivors [10]. The current multicenter study conducted by 3JECROG aims to retrospectively report long-term outcome and prognostic factors of definitive 3DCRT/IMRT alone or in combination with chemotherapy in locally advanced ESCC of stage III

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