Is extended volume external beam radiation therapy covering the anastomotic site beneficial in post-esophagectomy high risk patients?

Yu, Edward; Dar, R.; Rodrigues, George; Stitt, Larry; Videtic, Gregory M.M.; Truong, Pauline T.; Tomiak, Anna; Ash, Robert C.; Brecevic, E.; Inculet, Richard; Malthaner, Richard; Vincent, Mark; Craig, Ian; Kocha, Walter; Lefcoe, Michael S.

doi:10.1016/j.radonc.2004.08.024

Cited by 16 publications

(21 citation statements)

References 19 publications

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“…The initial rt target volume was defined with margins of 5 cm above and below the presurgical gross tumour volume, and a 2-cm margin to cover the mediastinal lymph nodes medially and laterally, with the superior margin extended at least 2 cm above the anastomotic site 10 (Figure 1). The boost fields had minimum 2-cm margins around the presurgical target volume.…”

Section: Methodsmentioning

confidence: 99%

“…Hematologic criteria for interruptions during concurrent chemotherapy rt included absolute neutrophil count below 1000/mm 3 ; neutropenic fever or sepsis; thrombocytes below 80,000/mm 3 . Locoregional symptomatology for treatment interruption included severe esophagitis (that is, severe odynophagia or dysphagia, intolerable pain), impaired nutrition with nausea and vomiting; and dehydration requiring hospitalization 10.…”

Section: Methodsmentioning

confidence: 99%

“…The literature contains limited retrospective or prospective information regarding the necessity for irradiation of the anastomosis and regarding the safety of the relatively large treatment volume when combined with chemotherapy postoperatively. We previously reported a retrospective analysis of extended-volume external-beam rt with a clinical target volume ( ctv ) covering the anastomotic site in post-esophagectomy high-risk patients 10. The present study was our local prospective pilot trial assessing the feasibility of incorporating the extended-volume regimen into rt planning for a postsurgical adjuvant trial in esophageal cancer.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Extended-Volume External-Beam Radiation Therapy in High-Risk Esophageal Cancer Patients: A Prospective Experience

Tai²,

Younus

et al. 2009

Current Oncology

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Background and PurposeExtended-volume external-beam radiation therapy (rt) following esophagectomy is controversial. The present prospective study evaluates the feasibility of extended-volume rt treatment in high-risk esophagectomy patients with a cervical anastomosis receiving postoperative combined chemoradiation therapy.Patients and MethodsFrom 2001 to 2006, 15 patients with resected esophageal cancer were prospectively accrued to this pilot study to evaluate the adverse effects of extended-volume rt. Postoperative management was carried out at London Regional Cancer Program. Eligibility criteria were pathology-proven esophageal malignancy (T3–4, N0–1), disease amenable to surgical resection, and esophagectomy with or without resection margin involvement. Patients with distant metastases (M1) and patients treated with previous rt were excluded. All 15 study patients received 4 cycles of 5-fluorouracil–based chemotherapy. External-beam rt was conducted using conformal computed tomography planning, with multi-field arrangement tailored to the pathology findings, with coverage of a clinical target volume encompassing the primary tumour bed and the anastomotic site in the neck. The radiation therapy dose was 50.40 Gy at 1.8 Gy per fraction. The rt was delivered concurrently with the third cycle of chemotherapy. The study outcomes—disease-free survival (dfs) and overall survival (os)—were calculated by the Kaplan–Meier method. Treatment-related toxicities were assessed using the U.S. National Cancer Institute’s Common Toxicity Criteria.ResultsThe study accrued 10 men and 5 women of median age 64 years (range: 48–80 years) and TNM stages T3N0 (n = 1), T2N1 (n = 2), T3N1 (n = 11), and T4N1 (n = 1). Histopathology included 5 adenocarcinomas and 10 squamous-cell carcinomas. Resection margins were clear in 10 patients. The median follow-up time was 19 months (range: 3.5–53.4 months). Before radiation therapy commenced, delay in chemotherapy occurred in 20% of patients, and dose reduction was required in 13.3%. During the concurrent chemoradiation therapy phase, 20% of the patients experienced chemotherapy delay, and 6.6% experienced dose reduction. No patient experienced treatment-related acute and chronic esophagitis above grade 2. Disease recurred in 40% of the patients (6/15), and median time to relapse was 24 months. No tumour recurred at the anastomotic site. The median dfs was 23 months, and the median os was 21 months.ConclusionsExtended-volume external-beam rt encompassing the tumour bed and the anastomotic site is feasible and safe for high-risk T3–4, N0–1 esophageal cancer patients after esophagectomy.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative Extended-Volume External-Beam Radiation Therapy in High-Risk Esophageal Cancer Patients: A Prospective Experience

Tai²,

Younus

et al. 2009

Current Oncology

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“…Besides, there is little information with regard to including [19] or not including surgical anastomosis in the irradiation field [20,21]. Despite the best improvements obtained through radiotherapy, local relapse is very high, so new strategies are under study for improving local control by increasing radiotherapy dosage.…”

Section: Discussionmentioning

confidence: 99%

“…HDR-BT was conducted one or two weeks later after external radiotherapy with a 7-mm diameter catheter. It included tumour pretreatment with a 2-cm cranium-caudal margin and the administration of a 16-Gy mean dose (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) in 2-4-week applications. Chemotherapy was administered concomitantly with external radiotherapy (f irst and last week) and was comprised of 5-FU and cisplatin.…”

Section: Discussionmentioning

confidence: 99%

High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED)

et al. 2007

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Radiotherapy for Esophageal Adenocarcinoma

Kwong

Lam

2018

Methods in Molecular Biology

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Adenocarcinomas occur in distal esophagus and often involve esophagogastric junction. Radiotherapy plays a key role in treatment, often in combination with chemotherapy and surgery in multi-modalities management. For resectable esophageal primaries, neoadjuvant chemoradiotherapy plus surgery can downstage disease and improve outcome over surgery alone. For patients with unresectable primaries or medically unfit for surgery, definitive chemoradiotherapy was found to improve survival over radiotherapy alone. For patients who had residual disease or involved margins after primary surgery, adjuvant chemoradiotherapy in postoperative setting was shown to improve local control and survival. Palliative radiotherapy can also be used to relieve local symptoms like dysphagia or bleeding. Careful radiotherapy planning is required to ensure adequate dose to target volumes without overdose to normal organs.

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Is extended volume external beam radiation therapy covering the anastomotic site beneficial in post-esophagectomy high risk patients?

Cited by 16 publications

References 19 publications

Postoperative Extended-Volume External-Beam Radiation Therapy in High-Risk Esophageal Cancer Patients: A Prospective Experience

Postoperative Extended-Volume External-Beam Radiation Therapy in High-Risk Esophageal Cancer Patients: A Prospective Experience

High dose rate brachytherapy (HDR-BT) in locally advanced oesophageal cancer. Clinic response and survival related to biological equivalent dose (BED)

Radiotherapy for Esophageal Adenocarcinoma

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