Clinical practice and outcome of radiotherapy for advanced esophageal squamous cell carcinoma between 2002 and 2018 in China: the multi-center 3JECROG Survey

Li, Chen; Wang, Xin; Wang, Lan; Chen, Junqiang; Zhang, Wencheng; Pang, Qingsong; Zhao, Yidian; Sun, Xinchen; Zhang, Kaixian; Li, Gaofeng; Li, Ling; Qiao, Xueying; Liu, Miaoling; Wang, Yadi; Deng, Lei; Wang, Wenqing; Bi, Nan; Tao, Zhen; Deng, Wei; Ni, Wenjie; Chang, Xiao; Han, Won Ho; Zhou, Zongmei; Liang, Jun; Feng, Qinfu; Wang, Lvhua; Chen, Dongfu; Lv, Jima; Zhu, Shuchai; Han, Chun; Xiao, Zefen

doi:10.1080/0284186x.2021.1902564

Cited by 19 publications

(27 citation statements)

References 31 publications

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“…Compared with the largest previous study, the multicenter 3JECROG Survey, the median OS in our studies was much lower. The 3JECROG Survey summarized 3,977 ESCC patients who received chemotherapy and definitive radiotherapy at the primary tumor between 2002 and 2018 from nine institutions in China ( 3 ); 23.3% of patients ( n = 928) were stage IV ESCC patients (according to the 6th TNM staging system), and the median OS of stage IVA and IVB patients was 17.2 months (95% CI: 15.0–19.3 months), and 16.6 months (95% CI: 14.7–18.5 months), respectively ( 3 ). No difference in OS was observed between stage IVA and stage IVB patients ( p = 0.12) ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…The 3JECROG Survey summarized 3,977 ESCC patients who received chemotherapy and definitive radiotherapy at the primary tumor between 2002 and 2018 from nine institutions in China ( 3 ); 23.3% of patients ( n = 928) were stage IV ESCC patients (according to the 6th TNM staging system), and the median OS of stage IVA and IVB patients was 17.2 months (95% CI: 15.0–19.3 months), and 16.6 months (95% CI: 14.7–18.5 months), respectively ( 3 ). No difference in OS was observed between stage IVA and stage IVB patients ( p = 0.12) ( 3 ). Furthermore, the survival of patients who received concurrent CRT was better than that of patients who received sequential CRT (OS: 23.5 months vs. 17.6 months, p < 0.001) ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…No difference in OS was observed between stage IVA and stage IVB patients ( p = 0.12) ( 3 ). Furthermore, the survival of patients who received concurrent CRT was better than that of patients who received sequential CRT (OS: 23.5 months vs. 17.6 months, p < 0.001) ( 3 ). Multivariate analysis in the concurrent CRT group found that patients receiving higher radiation dose (≥60 Gy) had a greater OS than those patients receiving low-dose radiotherapy (<50 Gy) (PFS: HR = 0.81, 95% CI: 0.68–0.98, p = 0.025; OS: HR = 0.77, 95% CI: 0.63–0.94, p = 0.009) ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Esophageal squamous cell cancer (ESCC) accounts for more than 90% of EC in Asia and is closely associated with having hot food or water and alcohol consumption ( 2 ). About 20.0% of patients present with stage IV at the time of diagnosis ( 3 ). Chemotherapy was the standard treatment before the appearance of novel systemic therapy, such as immunotherapy and target therapies ( 4 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Local Ablative Treatment Improves Survival in ESCC Patients With Specific Metastases, 2010–2016: A Population-Based SEER Analysis

Yang

Wang

et al. 2022

Front. Oncol.

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BackgroundWe aimed to explore the role of local ablative treatment (LAT) in metastatic esophageal squamous cell cancer (ESCC) patients who received chemotherapy and identify patients who will most likely benefit.MethodsWe analyzed data of metastatic ESCC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. The chi-square test was used to evaluate the unadjusted clinicopathological categorical variables between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors of overall survival. Propensity score matching (PSM) was used to adjust the differences between the two groups.ResultsOverall, 720 metastatic ESCC patients treated with chemotherapy were analyzed in this study; 63.2% of patients (n = 455) received LAT, including radiotherapy (n = 444), primary site surgery (n = 12), or lymph node dissection (n = 27). Gender (HR = 1.220, 95% CI: 1.024–1.453, p = 0.026), bone metastases (HR = 1.559, 95% CI: 1.292–1.882, p < 0.001), and liver metastases (HR = 1.457, 95% CI: 1.237–1.716, p < 0.001) were independent prognostic factors in the entire population. However, LAT was not an independent prognostic factor. Further subgroup analyses showed that LAT improved OS from 8.0 months to 10.0 months in patients with metastases other than bone/liver (HR = 0.759, 95% CI: 0.600–0.961, p = 0.022). LAT was not a prognostic factor in patients with bone/liver metastases (HR = 0.995, 95% CI: 0.799–1.239, p = 0.961). After PSM, the median OS was 8.0 months (95% CI: 7.2–8.8 months) and patients who received LAT had a better OS than patients without LAT (HR = 0.796, 95% CI: 0.653–0.968, p = 0.023). Patients with metastases other than bone/liver could benefit from LAT compared with those with bone/liver metastases.ConclusionsOur study indicated that metastatic ESCC patients with metastases other than bone/liver could derive additional benefit from LAT with systemic chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Local Ablative Treatment Improves Survival in ESCC Patients With Specific Metastases, 2010–2016: A Population-Based SEER Analysis

Yang

Wang

et al. 2022

Front. Oncol.

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“…This clinical trial will be conducted at the Medical Centre of Liaoning Cancer Hospital (Tertiary Medical Centre) in China. This trial is a prospective study, using the TOMO treatment device to study the safety and effectiveness of radiotherapy in patients with cancer of the head and neck tumours, 17 involving 120 enrolled patients. Using the random number table method, a random number sequence will be generated, and the patients will be enrolled in the experimental group and the control group in a 2:1 ratio.…”

Section: Methods and Analysismentioning

confidence: 99%

Radiotherapy for head and neck tumours using an oral fixation and parameter acquisition device and TOMO technology: a randomised controlled study

et al. 2021

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IntroductionRadiotherapy has become one of the main methods used for the treatment of malignant tumours of the head and neck. Spiral tomographic intensity-modulated radiotherapy has the many advantages of precision radiotherapy, which puts forward high requirements for postural reproducibility and accuracy. We will aim to ensure that the accurate positioning of the tumour will reduce the side effects of radiotherapy caused by positioning errors. We will design and implement this clinical trial using the patent of ‘a radiotherapy oral fixation and parameter acquisition device (patent number: ZL201921877986.5)’.Methods and analysisThis will be a randomised, controlled, prospective study with 120 patients with head and neck tumours. Using the random number table method, a random number sequence will be generated, and the patients will be enrolled in the experimental group (oral fixation device) and the control group (conventional fixation) in a 2:1 ratio. The primary outcome will be the progression-free survival time after the treatment. Secondary outcomes will include the oral mucosal reaction and the quality of life. Follow-ups will be carried out according to the plan. This is V.1.0 of protocol on 1 April 2021. The recruitment process for this clinical trial commenced on 1 May 2021, and will end on 1 October 2022.Ethics and disseminationThe trial received ethical approval from Medical Ethics Committee of Liaoning Provincial Cancer Hospital (number 20210131X). The final results will be presented at a scientific conference and published in a peer-reviewed journal in accordance with the journal’s guidelines.Trial registration numberChiCTR2100045096.

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Effectiveness of S-1–Based Chemoradiotherapy in Patients 70 Years and Older With Esophageal Squamous Cell Carcinoma

Wang,

Han,

Zhang

et al. 2023

JAMA Netw Open

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ImportanceDouble-agent intravenous chemotherapy concurrent with radiotherapy is the standard of care for patients with inoperable esophageal cancer. However, patients tend to tolerate intravenous chemotherapy less well with age and comorbidities. It is essential to find a better treatment modality that improves survival outcomes without reducing the quality of life.ObjectiveTo evaluate the effectiveness of simultaneous integrated boost radiotherapy (SIB-RT) with concurrent and consolidated oral S-1 chemotherapy for patients aged 70 years and older with inoperable esophageal squamous cell carcinoma (ESCC).Design, Setting, and ParticipantsThis multicenter, phase III randomized clinical trial was conducted between March 2017 and April 2020 in 10 centers in China. Patients with inoperable, locally advanced, clinical stage II to IV ESCC were enrolled and randomized to receive SIB-RT concurrent with and followed by oral S-1 chemotherapy (CRTCT group) or SIB-RT alone (RT group). Data analysis was completed on March 22, 2022.InterventionsIn both groups, the planning gross tumor volume was administered with radiation dose of 59.92 Gy and the planning target volume was administered with radiation dose of 50.4 Gy, in 28 fractions each. In the CRTCT group, concurrent S-1 was administered on radiotherapy days, and consolidated S-1 was administered at 4 to 8 weeks after SIB-RT.Main Outcomes and MeasuresThe primary end point was overall survival (OS) of the intent-to-treat population. Secondary end points were progression-free survival (PFS) and toxicity profile.ResultsA total of 330 patients (median [IQR] age, 75.5 [72-79] years; 220 [66.7%] male patients) were included, with 146 patients randomized to the RT group and 184 randomized to the CRTCT group. A total of 107 patients (73.3%) in the RT group and 121 patients (67.9%) in the CRTCT group were clinically diagnosed with stage III to IV disease. At the time of analysis of the 330 patients in the intent-to treat-population (March 22, 2022), OS was improved in the CRTCT group compared with the RT group at 1 year (72.2% vs 62.3%) and 3 years (46.2% vs 33.9%; log-rank P = .02). PFS was similarly improved in the CRTCT group compared with the RT group at 1 year (60.8% vs 49.3%) and 3 years (37.3% vs 27.9%; log-rank P = .04). There was no significant difference in the incidence of treatment-related toxic effects higher than grade 3 between the 2 groups. Grade 5 toxic effects occurred in each group, including 1 patient who experienced myelosuppression and 4 patients with pneumonitis in the RT group and 3 patients with pneumonitis and 2 patients with fever in the CRTCT group.Conclusions and RelevanceThese findings suggest that oral S-1 chemotherapy administered with SIB-RT should be considered as an alternative treatment option for patients aged 70 years and older with inoperable ESCC, since it improved survival outcomes without additional treatment-related toxic effects compared with SIB-RT alone.Trial RegistrationClinicalTrials.gov Identifier: NCT02979691

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Clinical practice and outcome of radiotherapy for advanced esophageal squamous cell carcinoma between 2002 and 2018 in China: the multi-center 3JECROG Survey

Cited by 19 publications

References 31 publications

Local Ablative Treatment Improves Survival in ESCC Patients With Specific Metastases, 2010–2016: A Population-Based SEER Analysis

Local Ablative Treatment Improves Survival in ESCC Patients With Specific Metastases, 2010–2016: A Population-Based SEER Analysis

Radiotherapy for head and neck tumours using an oral fixation and parameter acquisition device and TOMO technology: a randomised controlled study

Effectiveness of S-1–Based Chemoradiotherapy in Patients 70 Years and Older With Esophageal Squamous Cell Carcinoma

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