Dose escalation intensity-modulated radiotherapy–based concurrent chemoradiotherapy is effective for advanced-stage thoracic esophageal squamous cell carcinoma

Chang, Chin-Chih; Tsai, Hsieh‐Chih; Wei, Lin; Chang, Jer‐Hwa; Hsu, Han Lin; Chow, Jyh Ming; Yuan, Kuo; Wu, Alexander T.H.; Wu, Szu-Yuan

doi:10.1016/j.radonc.2017.08.025

Cited by 88 publications

(100 citation statements)

References 45 publications

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“…Although 50.4 Gy remains the standard dose of chemoradiation for esophageal cancer, authors of some large popular based retrospective studies showed the survival benefit of having a dose ≥60 Gy . The primary tumor position is the most frequent recurrence position after radiotherapy, suggesting an insufficient dose to the primary tumor.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10‐year survival outcomes

Fan

Wu²,

Wang

et al. 2019

Thoracic Cancer

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Background Concurrent chemoradiation is the standard treatment for locally advanced esophageal squamous cell carcinoma (SCC). We conducted a phase II study to explore the effect of three‐dimensional conformal radiotherapy (3‐DCRT) alone for patients with locally advanced esophageal SCC. This study aimed to analyze the long‐term survival outcomes. Methods Between November 2004 and April 2007, 30 patients with thoracic esophageal SCC underwent late‐course sequential boost 3‐DCRT at Fudan University Shanghai Cancer Center. The planning target volume (PTV1) comprised a 1.2–1.5 cm lateral margin around the gross tumor volume and a 3.0 cm margin, superior and inferior to the gross tumor volume. PTV2 encompassed the gross tumor volume with a margin of 0.5–0.7 cm. The PTV1 dose delivered was 50 Gy, and the PTV2 dose was a boost dose of 16 Gy, resulting in a total dose of 66 Gy. No chemotherapy was administered. Results The median follow‐up time was 30 months for all patients, and 132 months for patients who were alive. The median overall survival was 27 months (95% confidence interval [CI] 18.9–35.0). The 2‐, 5‐, and 10‐year overall survival rates were 56.6%, 33.3%, and 26.6%, respectively. The median progression‐free survival was 14 months (95% CI 7.7–20.2 months), and the 2‐, 5‐, and 10‐year progression‐free survival rates were 33.3%, 30.0%, and 26.6%, respectively. No severe late toxicity was observed in long‐term survivors. Conclusion Late‐course sequential boost 3‐DCRT is safe and feasible with promising long‐term outcomes for esophageal SCC.

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Section: Discussionmentioning

confidence: 99%

Three‐dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10‐year survival outcomes

Fan

Wu²,

Wang

et al. 2019

Thoracic Cancer

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“…Meanwhile, the results from propensity score and meta-analysis both showed survival advantage of IMRT for EC patients compared with traditional RT technique, such as 3D conformal RT (3D-CRT) [17,18]. Furthermore, on the basis of IMRT, definitive RT dose ≥60 Gy has yielded more favorable survival outcomes compared with standard dose 50.4 Gy in some latest researches [19,20], and the similar effect could be found in the elderly population without increasing treatment-related toxicities [21]. In the present study, all of very elderly patients were experienced IMRT and gained good short-term clinical effect, moreover, the subgroup of PGTV dose ≥ 60 Gy had superior LRFFS and better trends for OS (univariate analysis P = 0.055), these results indicated that dose escalation for tumor probably improve OS by enhancing LRFFS in very elderly EC patients, which also need to be further verified in prospective clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer

Zhou

Chen

et al. 2018

Cancer Medicine

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Because of the exclusion for the patients more than 75 years (very elderly patients) in many clinical trials of esophageal cancer (EC), there is no consensus on prognosis and treatment for this population. We aim to evaluate the outcomes and aging‐related prognostic factors of definitive radiotherapy (RT) for very elderly EC patients. We retrospectively analyzed 149 very elderly EC patients consecutively treated between January 2015 and June 2016 by definitive intensity‐modulated radiotherapy (IMRT) with or without chemotherapy. The clinical outcome and toxicities were assessed, and the potential prognostic factors, such as nutritional risk index (NRI) and neutrophil–lymphocyte ratio (NLR), were analyzed statistically. The median follow‐up time for survivors was 22.5 months. The 2‐year overall survival (OS), local–regional failure‐free survival (LRFFS), and distant metastasis‐free survival (DMFS) were 51.6%, 54.7%, and 85.2%, respectively. Independent predictors for poorer OS were higher American Joint Committee on Cancer (AJCC) stage, lower NRI, and higher NLR value before RT. Meanwhile, the total dose (cutoff value 60 Gy) of planning gross tumor volume (PGTV) and chemotherapy was also identified as independent prognostic indicator for LRFFS and DMFS, respectively. 72 patients had treatment failure and 58 (80.6%), 6 (8.3%), and 18 (25.0%) patients had experienced local, regional, and distant failure, respectively. Few severe toxicities were observed. The conservative definitive RT with modern technique was effective for very elderly EC patients in short term with low rate and tolerable toxicities. Local residue or recurrence was the most common failure pattern. The aging‐related prognostic factors concerned nutrition and immune, such as NRI and NLR before RT, should be considered for use in future clinical practice.

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“…Usually, therapeutic policy might be changed due to improvement in RT techniques . Higher dose RT approaches that use IMRT with or without CT may be associated with a higher local control, less toxicity, lower RT dose escalation, reduction in normal tissue RT dose, and possibly prolonged survival in patients with PA .…”

Section: Discussionmentioning

confidence: 99%

“…Our protocols were reviewed and approved by the Institutional Review Board of Taipei Medical University. The Cancer Registry database of the Collaboration Center of Health Information Application contains detailed cancer‐related information on clinical stages, RT doses, RT techniques, and CT regimens used .…”

Section: Methodsmentioning

confidence: 99%

Adjuvant radiotherapy and chemotherapy improve survival in patients with pancreatic adenocarcinoma receiving surgery: adjuvant chemotherapy alone is insufficient in the era of intensity modulation radiation therapy

Hsieh

Chang

et al. 2018

Cancer Medicine

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In the era of intensity modulation radiation therapy (IMRT), no prospective randomized trial has evaluated the efficacy of adjuvant therapies such as adjuvant concurrent chemoradiotherapy (CCRT), adjuvant sequential chemotherapy and radiotherapy (CT‐RT), and adjuvant CT alone in resectable pancreatic adenocarcinoma (PA). Through propensity score matching, we designed a nationwide, population‐based, head‐to‐head cohort study to determine the effects of dissimilar adjuvant treatments on resectable PA. We minimized the confounding of various adjuvant treatment outcomes among the following resectable PA groups of patients from the Taiwan Cancer Registry database: group 1, adjuvant CCRT; group 2, adjuvant sequential CT‐RT; and group 3, adjuvant CT alone. All the studied techniques are IMRTs. The matching process yielded a final cohort of 588 patients (196, 196, and 196 patients in groups 1, 2, and 3, respectively). In both univariate and multivariate Cox regression analyses, adjusted hazard ratios (aHRs; 95% confidence interval [CI]) of death derived for the adjuvant CCRT and adjuvant sequential CT‐RT cohorts compared with the adjuvant CT alone cohort were 0.398 (0.314–0.504) and 0.307 (0.235–0.402), respectively. A combination of adjuvant IMRT and CT for resectable PA treatment improves survival to a greater extent than does adjuvant CT alone.

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Dose escalation intensity-modulated radiotherapy–based concurrent chemoradiotherapy is effective for advanced-stage thoracic esophageal squamous cell carcinoma

Cited by 88 publications

References 45 publications

Three‐dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10‐year survival outcomes

Three‐dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10‐year survival outcomes

Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer

Adjuvant radiotherapy and chemotherapy improve survival in patients with pancreatic adenocarcinoma receiving surgery: adjuvant chemotherapy alone is insufficient in the era of intensity modulation radiation therapy

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