Abstract
Lots of controversies were found about the treatment in relation to radiation therapy (RT) for esophageal squamous cell carcinoma (ESCC). We designed a questionnaire of these controversies to do a pan-Chinese survey of radiation oncologists (ROs). For operable ESCC, 53% ROs chose surgery plus postoperative chemoradiotherapy (CRT), while 40% chose preoperative CRT plus surgery. For target volume of postoperative RT, most ROs (92%) would delineate tumor bed plus involved lymph nodes region before surgery. For definitive RT, most ROs (81%) would give patients higher RT dose to 60–65Gy. For radiation target volume, most ROs would give patients prophylactic irradiation of the bilateral superclavicular-lymph nodes region for cervical ESCC (93%), and the left gastric lymph nodes region for lower thoracic ESCC (72%). For the treatment of mediastinal lymph nodes, 72% ROs preferred elective nodal irradiation, while 28% did the involved nodal irradiation. For concurrent chemotherapy regimen, PF (5-Fu + cisplatin) and TP (cisplatin + paclitaxel) were used widely (49% and 46%, respectively). During simulation, four-dimensional computer tomography (4D CT) was not widely used (48%), even for cervical or lower thoracic ESCC (52%). For daily RT delivery, only 66% ROs would perform imaging guidance RT daily. In summary, more controversies existed in the treatment of ESCC with RT in China, including treatment strategy, radiation dose and target contour. Future goals include standardization of treatment strategy, radiation dose, and target contour, and application of 4D CT and daily imaging guidance, and pursuit of randomized trials in Chinese population.
Highlights
Esophageal cancer is the eighth most common cancer and the sixth leading cause of cancer-related mortality in the world [1]
Two-dimensional (2D) kilovoltage orthogonal imaging or electronic portal imaging device (EPID) daily (13%), three-dimensional (3D) kilovoltage cone-beam computer tomography (CBCT) or megavoltage (MV) four-dimensional computer tomography (CT) imaging for Tomotherapy weekly (53%), were used for imaging guided radiotherapy (IGRT). Results of this pan-Chinese survey of radiation oncologists (ROs) indicated that variation of practice occurs in the treatment of esophageal squamous cell carcinoma (ESCC) in China, including treatment strategy, simulation, radiation dose, target contour and radiation therapy (RT) delivery
Even majority of ROs (69%) knew the role of the CROSS trial, more than half of ROs chose surgery plus postoperative CRT rather than preoperative CRT plus surgery. What they (57% ROs) concerned is that neoadjuvant CRT may increase the risk of postoperative complications, such as bleeding, anastomotic leakage and healing delay, CROSS trial has demonstrated that trimodality is associated with similar adverse-event rates compared with surgery alone [15]
Summary
Esophageal cancer is the eighth most common cancer and the sixth leading cause of cancer-related mortality in the world [1]. The role of RT is established in the management of esophageal cancer, many controversies www.impactjournals.com/oncotarget exist on the treatment strategy and optimal radiation dose, as a result of the big differences on epidemiology, histology and tumor location for esophageal cancer between different countries [9]. For those reasons, the clinical management of esophageal squamous cell carcinoma (ESCC) including treatment strategy, may be highly variable across different countries and sometimes is likely guided by clinician experiences, even without high level evidence [9, 10]. For four-dimensional computer tomography (4D CT), it is widely used in the simulation for lung cancer [12], how does it extend to esophageal cancer remains unknown in China
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