BackgroundThis retrospective study on early and locally advanced esophageal cancer was conducted to evaluate locoregional failure and its impact on survival by comparing involved field radiotherapy (IFRT) with elective nodal irradiation (ENI) in combination with concurrent chemotherapy.MethodsWe assessed all patients with esophageal cancer of stages I-IV treated with definitive radiotherapy from June 2000 to March 2014. Between 2000 and 2011, ENI was used for all cases excluding high age cases. After Feb 2011, a prospective study about IFRT was started, and therefore IFRT was used since then for all cases. Concurrent chemotherapy regimen was nedaplatin (80 mg/m2 at D1 and D29) and 5-fluorouracil (800 mg/m2 at D1-4 and D29-32).ResultsOf the 239 consecutive patients assessed (120 ENI vs. 119 IFRT), 59 patients (24.7 %) had stage IV disease and all patients received at least one cycle of chemotherapy. The median follow-up time for survivors was 34.0 months. There were differences in 3-year local control (44.8 % vs. 55.5 %, p = 0.039), distant control (53.8 % vs. 69.9 %, p = 0.021) and overall survival (34.8 % vs. 51.6 %, p = 0.087) rates between ENI vs. IFRT, respectively. Patients treated with IFRT (8 %) demonstrated a significantly lower risk (p = 0.047) of high grade late toxicities than with ENI (16 %). IFRT did not increase the risk of initially uninvolved or isolated nodal failures (27.5 % in ENI and 13.4 % in IFRT).ConclusionsNodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients. Both tendencies of improved loco-regional progression-free survival and a significant increased overall survival rate favored the IFRT arm over the ENI arm in this study.
The quality-of-life score deteriorates once from before treatment due to acute complications by chemoradiotherapy, but recovers at 4 or 5 months and becomes better than before treatment.
About the bone marrow transplantation that high dose chemotherapy and total-body irradiation (TBI) are used for as conditioning regimen, a late toxicity may become the problem in the long-term survival patient. One of the toxicities which has been implied to be associated with TBI is secondary cacinogenesis. Between June 1995 and December 2010, 370 patients who were undergoing allogeneic hematopoietic stem cell transplantation using a TBI-based regimen at our department, were the subjects of this study. Eleven secondary cancers occurred in 10 patients. The median time from transplantation to diagnosis of a secondary cancer was 6.8 years. In this analysis, the cumulative incidence rate of secondary cancer at 5 and 10 years was 2.15% and 6.46%, respectively after TBI in our institution.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-2-424) contains supplementary material, which is available to authorized users.
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