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

Abstract

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.

The role of involved field irradiation versus elective nodal irradiation in definitive radiotherapy or chemoradiotherapy for esophageal cancer- a systematic review and meta-analysis

“…No significant differences were observed, although obvious heterogeneities were found among these studies (P < 0.00001; I 2 , 71%). As studies by Nakatani et al (24), Q. F. Li et al (26), and Zhu et al ( 22) contributed significantly and weighted similarly, we excluded these three studies and found that the 3-year OS rates remained unchanged (pooled RR, 0.93; 95% CI, 0.85-1.02; P = 0.15; moderate certainty), with no significant heterogeneity (P = 0.15; I 2 , 31%; Figure 2C). With regard to subgroup, the study type (Supplementary Figure 9A for RCTs group, and Supplementary Figure 9B for non-RCTs group), the type of radiotherapy (Supplementary Figure 10A for the 3D- CRT group, Supplementary Figure 10B for IMRT group, and Supplementary Figure 10C for 3D-IMRT-mixed group), the type of pathology (Supplementary Figure 11A for the ESCC group, and Supplementary Figure 11B for ESCC-mixed group), and the type of chemotherapy received (Supplementary Figure 12A for the CCRT group, Supplementary Figure 12B for CCRT+CT group, and Supplementary Figure 12C for CRTmixed group), there were no substantial differences between them.…”

“…No significant differences were observed, although obvious heterogeneities were found among these studies (P < 0.00001; I 2 , 74%). Subsequently, we excluded the study by Nakatani et al (24) and found that the IFI group had a significant advantage over the ENI group in terms of 5year OS rates (pooled RR, 0.78; 95% CI, 0.68-0.90; P = 0.0004; high certainty; Figure 2D), with no significant heterogeneity (P= 0.31; I 2 , 14%). With regard to subgroup, the type of radiotherapy, the IFI group had a significant advantage over the ENI group in the IMRT subgroup (Supplementary Figure 13A), whereas no differences were observed in the 3D-IMRT-mixed subgroup regarding the 5-year OS rate (Supplementary Figure 13B).…”

“…With regard to subgroup, the type of pathology, the ESCC-mixed subgroup (Supplementary Figure 14B) showed a significant 5-year OS benefit but not the ESCC subgroup; however, obvious heterogeneities were found among these studies (P = 0.0003; I 2 , 73%). Therefore, we excluded the study by Nakatani et al (24) and found that the IFI group had an advantage over the ENI group in 5-year OS rates, with no significant heterogeneity (Supplementary Figure 14A). Analysis of other subgroups was not conducted due to the lack of interested outcomes.…”

“…However, obvious heterogeneities were found among these studies at 5-year PFS rate (P < 0.0001; I 2 , 71%). Subsequently, we excluded the study by Nakatani et al (24) and re-evaluated the 5-year PFS rate. We showed that the IFI group had an advantage over the ENI group (pooled RR, 0.81; 95% CI, 0.70-0.93; P = 0.003; high certainty; Figure 4D) with no heterogeneity (P= 0.40; I 2 , 5%).…”

Endoscopic resection as an independent predictive factor of local control in patients with T1bN0M0 esophageal squamous cell carcinoma treated with chemoradiotherapy: a retrospective study

“…In the JCOG 9708 study, although 87.5% of patients achieved complete remission, the 4-year recurrence-free survival rate was 52.8%. According to existing studies, overall recurrence rate after radiotherapy (RT) or CRT for stage I ESCC was 20–40%, while the intraesophageal recurrence rate was 10–30% [ 5 – 9 ].…”