Comparison between the effects of elective nodal irradiation and involved‐field irradiation on long‐term survival in thoracic esophageal squamous cell carcinoma patients: A prospective, multicenter, randomized, controlled study in China

Lyu, Jiahua; Abulimiti, Yisikandaer; Li, Tao; Zhang, Xiaozhi; Wang, Xiaohu; Tian, Zhongge; Chen, Long; Liu, Bing; Chen, Hong; Yang, Jie; Wang, Qifeng; Zhang, Jinnrong; Ma, Yingnan; Liu, Rui; Liu, Ruifeng; Hage, Aiguri; Lang, Jinyi

doi:10.1002/cam4.3409

Cited by 20 publications

(24 citation statements)

References 19 publications

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“…Several retrospective and prospective studies have found that the main failure mode after IFI is still in-field recurrence and distant metastasis, rather than isolated out-of-field nodal recurrence only ( 30 ). ENI only improves local control but does not improve the long-term survival of patients with EC, and the efficacy of IFI and ENI is essentially similar ( 31 , 32 ). For ENI irradiation mode, the target area volume is not conducive to the protection of peripheral circulating lymphocytes because it covers many large blood vessels and lymphatic tissues in the cervicothoracic region.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of absolute lymphocyte count in patients with advanced esophageal cancer treated with immunotherapy: a retrospective analysis

Zhao¹,

Bi²,

Xue³

et al. 2022

Ann Transl Med

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Background: Immunotherapy has become the standard of treatment for recurrent metastatic esophageal cancer (EC), and the value of efficacy predictive markers represented by programmed death-ligand 1 (PD-L1) is limited. The purpose of this study is to analyze the prognostic value of peripheral blood absolute lymphocyte count (ALC) at baseline in patients with recurrent metastatic EC treated with immunotherapy, and to further investigate the relationship between the minimal ALC value (Min ALC) and radiotherapy (RT) parameters. Methods:The main inclusion criteria were: histologically or imaging confirmed recurrent or metastatic EC; complete routine blood test data. A total of 105 patients were included in a single-center institution, 65 of whom had previously received RT. The optimal cut-off value for baseline lymphopenia was determined by the receiver operating characteristic (ROC) curve. The prognostic value of baseline phase lymphopenia for immunotherapy were determined by cox regression analysis and the associated factors affecting lymphopenia were explored by logistic regression analysis. Results:The cut-off value for baseline ALC predicting 1-year overall survival (OS) was 625 cells/μL. The OS was significantly lower in the lymphopenia group (ALC ≤625 cells/μL) than in the non-lymphopenia group (ALC >625 cells/μL) (median OS: 6 vs. 12 months, P=0.002). Multivariate analysis showed that preimmunotherapy lymphopenia was an important factor influencing patient prognosis [hazard ratio (HR): 1.771, 95% confidence interval (CI): 1.051-2.985; P=0.032)] (adjusted for clinical factors including sex, age, tumor location, histology, degree of differentiation, distant metastasis, use of RT). Patients with a previous grade 4 (G4) Min ALC during RT were more likely to develop pre-immunotherapy lymphopenia following diagnosis of recurrent metastasis [odds ratio (OR): 10.809, 95% CI: 2.185-53.471; P=0.004]. Planning target volume (PTV) volume greater than 521.2 cm 3 (OR: 19.981, 95% CI: 1.372-290.985; P=0.028) was an independent risk factor affecting the G4 Min ALC during RT.Conclusions: Lymphopenia is associated with a poorer immunotherapy prognosis in patients with recurrent metastatic EC and those with previous G4 Min ALC after RT. RT-related parameters, especially irradiation volume, can significantly affect lymphocyte counts.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of absolute lymphocyte count in patients with advanced esophageal cancer treated with immunotherapy: a retrospective analysis

Zhao¹,

Bi²,

Xue³

et al. 2022

Ann Transl Med

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“…A retrospective study demonstrated that for patients with positive lymph node metastasis, high-risk regions may receive considerable incidental irradiation doses even if ENI was not used [7] , which means that this incidental irradiation may contribute to the control of micro-metastasis. In the aforementioned studies, only thoracic esophageal cancer patients [4,7,8] or less than 13% of cervical esophageal cancer patients [9,10,12,13] were included. It was unclear that if we should deliver the target of the prophylactic lymphatic area for CESCC patients.…”

Section: Discussionmentioning

confidence: 99%

Elective nodal irradiation versus involved-field irradiation for stage Ⅱ-Ⅳ cervical esophageal squamous cell carcinoma patients undergoing definitive concurrent chemoradiotherapy: a retrospective propensity study with eight-year survival outcomes

Wang

Zhang

et al. 2022

Preprint

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Background Definitive concurrent chemoradiotherapy (dCCRT) is suggested as the standard treatment for cervical esophageal squamous cell carcinoma (CESCC). This retrospective propensity study compared the eight-year survival outcomes and acute treatment toxicities of these patients treated with elective nodal irradiation (ENI) versus involved-field irradiation (IFI). Materials and Methods Patients with stage Ⅱ-Ⅳ CESCC treated with dCCRT at the Fourth Hospital of Hebei Medical University between January 1, 2007 and December 31, 2020 were enrolled in the study. All the patients were restaged according to the American Joint Commission (AJCC) 8th edition criteria. The propensity score matching (PSM) was used to minimize the effects of treatment selection bias and potential confounding factors including sex, age, ECOG score, clinical T stage (cT), clinical N stage (cN), clinical TNM stage (cTNM) and radiation dose between the ENI group and IFI group. Survival and the prognostic factors were evaluated. Results The 131 eligible patients underwent ENI (60 patients, 45.8%) or IFI (71 patients, 54.2%). The median follow-up time was 91.1 months (range, 23.8–182.0 months) for all the patients. The median OS, 1-, 3-, 5-, and 8-year OS rates were 44.4 months, 87.8%, 55.1%, 38.3%, and 27.2%, respectively. After PSM, there were 49 patients in each group. The median OS, 1-, 3-, 5-, and 8-year OS rates for ENI and IFI group were 32.0 months, 83.7%, 48.5%, 38.5% and 31.1% versus 45.2 months, 89.8%, 52.5%, 37.5%, 26.1%, respectively (P = 0.966; HR 0.99, 95%CI 0.61–1.61). Similar locoregional control was obtained in both groups. The tendency of leukocytopenia and neutropenia was higher in ENI than in IFI (59.2% versus 38.8%; P = 0.068 and 30.6% versus 14.3%; P = 0.089) at the end of dCCRT. Conclusion Cervical esophageal squamous cell carcinoma patients undergoing definitive concurrent chemoradiotherapy has a satisfactory prognosis with organ conservation. The involved-field irradiation might be a better alternative owing to similar overall survival outcomes and local control with less toxicity of myelosuppression.

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“…Significant decreases were seen in treatment-related esophagitis and pneumonitis with IFI versus ENI. The authors suggest IFI may be superior to ENI in treatment of stage II–III thoracic ESCC due to improved rates of adverse effects, with a similar effect on long-term survival [ 37 ]. In contrast, Xie et al compared CRT with ENI versus CFI in 352 patients with locally advanced ESCC.…”

Section: Radiation Therapy Approachmentioning

confidence: 99%

Approach to Localized Squamous Cell Cancer of the Esophagus

Weidenbaum

Gibson

2022

Curr. Treat. Options in Oncol.

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Opinion statementEsophageal cancer is a leading cause of cancer deaths worldwide, with an increasing incidence in recent decades. The majority of esophageal cancers are squamous cell carcinoma. The 5-year survival rate of esophageal squamous cell carcinoma (ESCC) is poor, and there remains globally a pressing need for novel treatments that improve patient outcomes and quality of life. In this review, we discuss management of localized ESCC with an update on relevant newly published literature, including targeted therapy and novel biomarkers. The standard treatment approach for locally advanced, resectable ESCC is currently chemoradiation with or without surgery. Here we discuss different approaches to endoscopic resection, surgery, and radiation therapy. Although the typical chemotherapy regimen is a combination of a platinum with a fluoropyrimidine or paclitaxel, different regimens are being evaluated. With the landscape of immunotherapy rapidly evolving, at the forefront of new treatments for ESCC is immunotherapy and other targeted agents. Ultimately, the treatment approach should be individualized to each patient.

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Comparison between the effects of elective nodal irradiation and involved‐field irradiation on long‐term survival in thoracic esophageal squamous cell carcinoma patients: A prospective, multicenter, randomized, controlled study in China

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 20 publications

References 19 publications

Prognostic value of absolute lymphocyte count in patients with advanced esophageal cancer treated with immunotherapy: a retrospective analysis

Prognostic value of absolute lymphocyte count in patients with advanced esophageal cancer treated with immunotherapy: a retrospective analysis

Elective nodal irradiation versus involved-field irradiation for stage Ⅱ-Ⅳ cervical esophageal squamous cell carcinoma patients undergoing definitive concurrent chemoradiotherapy: a retrospective propensity study with eight-year survival outcomes

Approach to Localized Squamous Cell Cancer of the Esophagus

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