Adjuvant Radiotherapy of Involved Field versus Elective Lymph Node in Patients with Operable Esophageal Squamous Cell Cancer: A Single Institution Prospective Randomized Controlled Study

Abstract

Background: To evaluate locoregional failure and its impact on survival by comparing involved field irradiation (IFI) with elective lymph node irradiation (ENI) for patients with esophageal squamous cell cancer who underwent post-operative radiotherapy. Methods and Materials: The enrolled patients were randomized allocated to IFI or ENI group. CTV of IFI was generated according to pre-operative primary tumor location and post-operative pathological characters and positive LNs regions. CTV of ENI was generated according to pre-operative tumor position to administer selective lymph node irradiation. Radiotherapy planning was delivered using either 3D-CRT or IMRT. Results: A total of 57 patients were enrolled, 28 patients in ENI group and 29 patients in IFI group. There were not statistical differences between two groups in baseline (p>0.05). The initial locoregional failure rate was 17.9 % in ENI arm and 20.7% in IFI arm respectively (p=0.085). The 1-, 3-, and 5-year Progression-free Survival (PFS) were 63.2, 43.5, and 21.8 % in ENI arm versus 78.2, 60.1, and 55.1% in IFI arm (p =0.038). The 1-, 3-, and 5-year overall survival (OS) were 78.6, 46.9, and 23.5 % in ENI arm versus 72.9, 59.7, and 54.3 % in IFI arm (p=0.06). Acute radiation pneumonitis (p=0.005) and hematological toxicities (p =0.029) also showed statistical differences between groups, ENI arm was more than IFI arm. Conclusions: The results indicated that IFI tended to improve survival and reduce toxicities for patients with operative ESCC and did not increase locoregional failure compared to ENI. It is thus suggested that IFI for ESCC PORT is worthy of clinical recommendation and further study.

Involved-field irradiation versus elective nodal irradiation in patients with locally advanced esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy

“…Our preliminary results demonstrated that the survival outcomes did not differ signi cantly, consistent with the results of other studies [27]. Before 2021, our center mainly adopted ENI irradiation (168/208 patients, 80.0%).…”

A comparative study of elective nodal irradiation and involved field irradiation in elderly patients with advanced esophageal cancer

“…Li et al (11) analyzed 110 esophageal cancer patients (including 56 in the ENI group and 54 in the IFI group), and found that the IFI group had significantly lower incidence of grade ≥2 radiation pneumonitis and radiation esophagitis compared to the ENI group (12.9% vs. 26.8%, P=0.011; 20.4% vs. 37.5%, P=0.001). Liu et al (12) found that the incidence of acute radiation pneumonitis (p=0.005) and hematologic toxicity (p=0.029) was significantly higher in the ENI group compared to the IFI group. Cheng et al ( 13) also observed that the incidence of grade ≥3 acute esophagitis and pneumonitis was significantly lower in the IFI group compared to the ENI group.…”

“…Liu et al. ( 12 ) found that the incidence of acute radiation pneumonitis (p=0.005) and hematologic toxicity (p=0.029) was significantly higher in the ENI group compared to the IFI group. Cheng et al.…”

Gold Nanocage-Based Multifunctional Nanosensitizers for Programmed Photothermal /Radiation/Chemical Coordinated Therapy Guided by FL/MR/PA Multimodal Imaging

“…It is unwise to exert excessive radiation dosages in the therapy process to obtain the desirable radiotherapeutic efficacy, as blindly increasing the radiation dosage can not increase the efficacy of radiotherapy but aggravate the injury of normal tissue. 11,12 The employment of radiosensitizers may be a proper strategy to overcome the radiation resistance and achieve relatively safe and low-dosed radiation therapeutics. 13 The combination treatment is also regarded as an effective solution to optimize therapeutic effect.…”