Choice of Radiotherapy Planning Modality Influences Toxicity in the Treatment of Locally Advanced Esophageal Cancer

Mackley, Heath B.; Adelstein, Jonathan S.; Reddy, Chandana A.; Adelstein, David J.; Rice, Thomas W.; Saxton, Jerrold P.; Videtic, Gregory M.M.

doi:10.1007/s12029-009-9067-x

Cited by 8 publications

(3 citation statements)

References 27 publications

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“…3D treatment planning and a multiple portal technique may reduce toxicities related to radiation. Mackley et al reported reduced acute esophagitis in patients with locally advanced esophageal cancer, due to the 3D treatment planning [16]. We infer that 3D treatment planning with 3-or 4-portals used in the IFI group might contribute to lower incidences of late toxicities.…”

Section: Discussionmentioning

confidence: 72%

Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer

et al. 2020

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BackgroundThe optimal radiation field of chemoradiation therapy (CRT) for stage I esophageal squamous cell carcinoma (ESCC) is unknown. This retrospective study compared efficacy and safety of two CRT modalities, involved field irradiation (IFI) and elective nodal irradiation (ENI), when treating patients with clinical stage I (T1bN0M0) ESCC. MethodsPatients had received 60 Gy CRT concurrently with 5-FU and cisplatin between January 2000 and December 2012. The clinical target volume of IFI was limited to the primary tumor plus a 2-cm craniocaudal margin; that of ENI covered the primary tumor plus the field of regional lymph nodes. ResultsOne hundred and ninety-five patients were selected (IFI group, 78; ENI group, 117). The 5-year overall, cause-specific and progression-free survival rates were 90.5%, 91.6% and 77.6% in the IFI group, and 72.5%, 88.3%, 57.9% in the ENI group, respectively. Of recurrent patients (n=16 in the IF and n=33 in the ENI groups) after achieving complete remission, 12 (75%) in the IFI group received definitive salvage therapy, 11 (33%) patients did in the ENI group. More patients died of diseases other than esophageal cancer in the ENI group (n=29, 25%) than in the IFI group (n=3, 3.8%). Multivariate analysis identified ENI (HR 3.

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Section: Discussionmentioning

confidence: 72%

Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer

et al. 2020

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“…Mackley et al report less toxicity with 3D-RT in comparison to 2D-RT in esophageal carcinoma, with no impact on survival. 18 Improved local control, OS, and less toxicity for 3D-RT has also been reported in other carcinomas, such as prostate and lung cancer. 17,19 In our study, patients treated with SC-RT had a poorer OS rate than patients treated with CF-RT.…”

Section: Discussionmentioning

confidence: 91%

Primary radiotherapy with or without chemotherapy in non-metastatic esophageal squamous cell carcinoma: a retrospective study

Fakhrian¹,

Heilmann²,

Schuster³

et al. 2011

Diseases of the Esophagus

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The purpose of this study was to report the outcome of radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 163 patients with T1-T4, N0-1, M0 ESCC who were treated between January 1988 and December 2006 at the Technische Universität München. One hundred sixty patients were inoperable due to a poor performance status, comorbidities or locally advanced unresectable disease. External beam radiation therapy (EBRT) was performed with (n= 146) or without (n= 17) systemic chemotherapy. Fifty-four patients received an additional boost with intraluminal brachytherapy (IBT). Surviving patients were followed for a median of 72 months (range 10-173 months). The estimated overall survival (OS) at 2 and 5 years was 27 ± 4% and 11 ± 3%, respectively. Loco-regional recurrence at the primary site was observed in 29% of patients (n= 47). The recurrence-free survival (RFS) at 2 and 5 years was 24 ± 3% and 9 ± 2%, respectively. In multivariate analyses, the ECOG performance status (P= 0.004), 3D conformal (vs conventional) radiotherapy (P= 0.031) and continuous standard fractionation (vs split-course radiotherapy, P= 0.048) were associated with a better OS. Simultaneous chemotherapy (P= 0.49) or IBT (P= 0.31) had no significant impact on survival. Outcome for patients with ESCC is poor. Despite the very unfavorable patient selection (poor performance status, high rate of comorbidities, and advanced disease), long-term survival with radio(chemo)therapy was achieved in about 10% of patients. The introduction of modern treatment techniques/modalities (3D conformal planning/ continuous standard fractionation) might be associated with better outcomes.

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“…In recent years, three-dimensional computed tomography (CB)-based radiotherapy planning (3D planning) has become the mainstream. Mackley et al [ 6 ] showed that the number of patients who had esophagitis was significantly smaller in patients for whom 3D planning was performed than in patients for whom 2D planning was performed. Moreover, the method of position matching for daily radiotherapy has been improving.…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of clinical outcomes for patients with esophageal cancer who were treated with radiotherapy alone

Takahashi,

Umezawa,

Yamamoto

et al. 2024

Gastrointest Tumors

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Introduction: Patients with esophageal cancer who are in a poor general condition receive radiotherapy alone, but outcomes are often unsatisfactory. The aim of this study was to clarify recent outcomes of radiotherapy alone for esophageal cancer. Methods: Patients who underwent 50 Gy or more of radiotherapy without chemotherapy were retrospectively reviewed. Endpoints were overall survival (OS), disease-specific survival (DSS), local control (LC), and progression-free survival (PFS). Survival curves were drawn using the Kaplan-Meier method and predictors were analyzed using the Cox proportional hazards model. Results: Sixty-nine patients were included. The median follow-up period was 17.9 months. The 5-year OS, DSS, LC, and PFS rates were 33.2%, 49.8%, 46.2%, and 16.8%, respectively. In the multivariate Cox proportional hazard model, clinical stage was a significant predictor for OS (hazard ratio [HR]: 4.42, 95% confidence interval [CI]: 1.80 – 11.17, p = 0.001), DSS (HR: 2.08, 95% CI: 1.43 – 3.12, p = 0.0001), LC (HR: 1.86, 95% CI: 1.28 – 2.74, p = 0.001), and PFS (HR: 1.65, 95% CI: 1.25 – 2.18, p = 0.0004). Radiation dose was a significant predictor for LC (HR: 0.87, 95% CI: 0.78 – 0.97, p = 0.018) and tumor location was a significant predictor for PFS (HR: 1.55, 95% CI: 1.10 – 2.19, p = 0.018). In subgroup analysis, the 5-year OS, DSS, LC, and PFS rates for stage I were 60.0%, 80.0%, 71.9%, and 46.1%, respectively. Conclusions: Stage, radiation dose and tumor location are significant predictors for outcomes. Patients with stage I esophageal cancer can be cured by radiotherapy alone.

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Choice of Radiotherapy Planning Modality Influences Toxicity in the Treatment of Locally Advanced Esophageal Cancer

Abstract: 3DCTP reduces acute esophagitis in patients receiving multimodality therapy for esophageal cancer without compromising clinical outcomes.

Cited by 8 publications

References 27 publications

Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer

Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer

Primary radiotherapy with or without chemotherapy in non-metastatic esophageal squamous cell carcinoma: a retrospective study

A retrospective study of clinical outcomes for patients with esophageal cancer who were treated with radiotherapy alone

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