Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analysis

Liu, Mina; Zhao, Kuaile; Chen, Yun; Jia, Guanghong

doi:10.1186/s13014-014-0232-4

Cited by 40 publications

(45 citation statements)

References 15 publications

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“…Liu et al studied 169 elderly EC patients receiving IFI and ENI and the results showed that no significance difference was seen for OS and in-field recurrence and distal organ metastasis between the two groups [20]. Our results also showed that no significant difference was found between IFI and ENI in relation to the reported outcomes and toxicities in these studies.…”

Section: Discussionsupporting

confidence: 68%

Radiotherapy Alone or Concurrent Chemoradiation for Esophageal Squamous Cell Carcinoma in Elderly Patients

Zhao

Zhou

Yin

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose: The reported data of elderly ESCC are rather limited and there is a lack of information to guide treatment decisions for elderly patients with esophageal cancer. This study aims to identify the efficacy and factors for optimal treatment approaches for elderly esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (RT) alone or concurrent chemoradiation (CCRT). Methods: This study included 184 I-III elderly ESCC patients aged ≥70 years treated by oral single agent CCRT (sCCRT) or double agents CCRT (dCCRT) or RT alone at a single institution in China. RT was delivered with Intensity Modulated Irradiation Therapy (IMRT) or Volumetric-Modulated Arc Therapy (VMAT). Sequential or simultaneous integrated boost (SIB) approach was applied for GTV dose escalation. Toxicities were evaluated by criteria of Radiation Therapy Oncology Group. Statistical analyses were performed on survival and failure patterns. Results: At a median follow-up time of 15.5 months, the 2-and 3-year estimated overall survival (OS) were 43.5% and 35.2%, respectively. T and N stage, GTV dose (cutoff value 56Gy), simultaneous integrated boost (SIB) technique and CCRT were significant predictors for the outcomes. sCCRT was significantly associated with higher OS, LRFS, and DFS when compared with RT alone and no difference was observed between sCCRT and dCCRT. 44% patients experienced treatment failure, among whom 65.4% developed local failure. 81.3% local failure occurred in GTV and 70.6% regional failures occurred out of radiation field. dCCRT was the only independent prediction factor for grade ≥ 2 neutropenia and gastrointestinal reactions compared with sCCRT and RT alone. No significant difference of toxicities was observed between sCCRT and RT alone. Conclusions: Our results demonstrated that CCRT in elderly patients had significant survival benefit compared to RT alone, especially using Single oral agent. sCCRT had less toxicities compared to dCCRT, and the toxicity was similar to RT alone. GTV dose ≥ 56 Gy and SIB technique were optimal approaches for radiotherapy.

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Section: Discussionsupporting

confidence: 68%

Radiotherapy Alone or Concurrent Chemoradiation for Esophageal Squamous Cell Carcinoma in Elderly Patients

Zhao

Zhou

Yin

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…After reading the abstracts, twenty were excluded for repeated published data, two for using 2-dimensional technology, fouthteen for being non-case-control studies. Eventually, nine studies involing 1143 ESCC patients were included in this meta analysis [4][5][6][7][8][9][10][11][12]. The basic characteristics and results of included studies were shown in Tables 1 and 2.…”

Section: The Retrieval Results and Quality Evaluationmentioning

confidence: 99%

“…Liu M et al [11] 2014 169 I~IV IFI: a 1 cm margin was added around GTV, but 3cm margins in the esophageal long axis superiorly and inferiorly to encompass potential submucosal invasions. ENI: covered supraclavicular area with the upper margin at the caudal edge of cricoid cartilage, inferior margin at the sternal notch.…”

Section: Discussionmentioning

confidence: 99%

Comparasion of elective nodal irradiation and involved-field irradiation in esophageal squamous cell carcinoma: a meta analysis

Jing¹,

Wang²,

Zhu³

et al. 2018

Oncotarget

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It is still controversial whether radical radiotherapy in patients with esophageal squamous cell carcinoma (ESCC) still requires elective nodal irradiation (ENI), or only involved-field irradiation (IFI). In this study, a meta analysis was used to compare ENI and IFI in the treatment of ESCC, in order to provide guidance for clinical practice. Methods: Literatures on ENI and IFI in treatment of ESCC were retrieved, and the last access was June 30, 2017. A meta analysis was performed to evaluate the advantage and disadvantage of ENI and IFI. Results: Nine studies with a total of 1143 patients were included in this analysis, of those 605 patients underwent radiotherapy only, and 538 underwent radiochemotherapy. There was no significant difference in 1-, 2-, 3-year local control rate between ENI and IFI, or 1-, 2-, 3-year overall survival rates. However, the incidences of ≥ 3 grade acute esophagitis and pneumonia were significantly lower in IFI group. There was no difference in the rate of out-field recurrence/metastasis in this two groups. Conclusions: Neither local control rates nor overall survival rates between ENI and IFI groups have significant differences, but in the latter group, incidences of severe radiation esophagitis and pneumonia are significantly lower. IFI is not associated with increasement of out-field recurrence/ metastasis. It is noteworthy that most of the included studies are retrospective. Therefore, a large prospective randomized study is needed for further investigation and verification.

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“…In a prospective randomized trial, Ma et al 21 compared eni with ifi in patients with cervical and upper thoracic eca, observing no significant difference in the 3-year os or locoregional control rate between the ifi and eni groups (32.0% and 80.1% vs. 41.3% and 85.7% respectively). Liu et al 22 noted that out-of-field regional cervical node metastasis occurred in 8% of the ifi group and 10% of the eni group in patients with cervical and upper thoracic eca. Use of eni did not result in better os or long-term control in cervical lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Zhao

Zhang

et al. 2016

Current Oncology

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Objectives Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus.Methods Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time.Results In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively. ConclusionsFor patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

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Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analysis

Cited by 40 publications

References 15 publications

Radiotherapy Alone or Concurrent Chemoradiation for Esophageal Squamous Cell Carcinoma in Elderly Patients

Radiotherapy Alone or Concurrent Chemoradiation for Esophageal Squamous Cell Carcinoma in Elderly Patients

Comparasion of elective nodal irradiation and involved-field irradiation in esophageal squamous cell carcinoma: a meta analysis

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

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