Late Toxicity After Definitive Concurrent Chemoradiotherapy for Thoracic Esophageal Carcinoma

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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“…Morota et al 19 . reported a 7% regional failure rate in patients with thoracic eca undergoing ccrt using eni.…”

Section: Discussionmentioning

confidence: 98%

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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“…Morota et al investigated 74 patients who were treated with definitive concurrent CRT using an extended field from the supraclavicular fossa to the gastroesophageal junction, and concluded that the risk of grade 3 or greater cardiopulmonary toxicities was greater in patients aged > 75 years (29% vs 3%). 25 In Radiation Therapy Oncology Group (RTOG) 85-01, 28% of patients had grade 3 or higher toxicity, but only 1 of those cases was related to cardiopulmonary disease. 26 Ishikura et al have shown that large-field RT with concurrent chemotherapy has a high rate (12%) of grade 3 or higher cardiopulmonary toxicity.…”

Section: Discussionmentioning

confidence: 99%

The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer

Wojcieszynski

Berman²,

Wan³

et al. 2013

Cancer

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BACKGROUND: The addition of chemoradiation (CRT) to surgery has been shown to improve survival in patients with esophageal cancer. In the current study, the authors determined whether the sequencing of CRT has an effect on survival and cardiopulmonary mortality in patients with esophageal cancer. METHODS: Patients with the following inclusion criteria were identified within 17 Surveillance, Epidemiology, and End Results registries from 1988 through 2007: adenocarcinoma or squamous cell carcinoma of the esophagus and having undergone esophagectomy. Patients who died within 90 days of surgery were excluded. Demographic, tumor, and survival data were compared between patients receiving preoperative and postoperative RT. Cox proportional hazards regression models were calculated to identify parameters associated with cause-specific survival and overall survival. A competing risk analysis was performed to account for death due to esophageal cancer in the calculation of cardiopulmonary mortality. RESULTS: Of 5512 patients, 1881 received preoperative RT, 901 received postoperative RT, and 2730 did not receive RT. Patients receiving preoperative RT had improved 5-year cause-specific survival (41% vs 31%; P < .0001) and overall survival (33% vs 23%; P < .0001) compared with those receiving postoperative RT. No differences in adjusted cardiopulmonary mortality were found between patients who received RT versus those who did not (8% vs 10% at 10 years; hazards ratio [HR] KEYWORDS: esophageal neoplasms, combined modality therapy, radiation oncology, survival, heart diseases, lung diseases. INTRODUCTIONIn patients with locally advanced esophageal cancer, the addition of chemoradiation (CRT) to surgery has shown improvements in overall survival (OS) when given preoperatively. [1][2][3][4][5][6] In the subset of patients with tumors of the gastroesophageal junction, CRT delivered postoperatively has also demonstrated a survival benefit. 7 To the best of our knowledge, no randomized controlled trials currently exist that compare the outcomes of the sequencing of CRT in relation to surgery in patients with esophageal cancer.Preoperative CRT is preferred over postoperative treatment in patients with other gastrointestinal malignancies such as rectal cancer, in whom preoperative CRT has been demonstrated to have a superior locoregional control rate, toxicity profile, and survival rate. 8,9 It is postulated that preoperative treatment is favored because of tumor downstaging and smaller radiation treatment fields. We hypothesized that preoperative RT is associated with decreased cardiopulmonary mortality from lower RT doses to the heart and lungs as well as improved survival outcomes compared with postoperative RT in patients with esophageal cancer.Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, we assessed differences in survival outcomes between patients treated with preoperative RT and those treated with postoperative RT and analyzed the effect of RT on heart and lung morbidity a...

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“…In the long-term report by Ishikura et al, 10 severe heart-related adverse events occurred in about 7.2% of cases; Kumekawa et al 18 reported 8.2% and Morota et al 19 reported 5.4%. The present study had four observed cases (2.8%) of severe heartrelated adverse events of grade 3 or higher, including pleural effusion ( Table 3).…”

Section: Fukada Et Almentioning

confidence: 95%

Predictive factors for pericardial effusion identified by heart dose–volume histogram analysis in oesophageal cancer patients treated with chemoradiotherapy

Hayashi¹,

Fujiwara²,

Nomura³

et al. 2015

BJR

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with oesophageal cancer treated with chemoradiotherapy (CRT) using the following criteria were evaluated: radiation dose .50 Gy; heart included in the radiation field; dose-volume histogram (DVH) data available for analysis; no previous thoracic surgery; and no PCE before treatment. The diagnosis of PCE was independently determined by two radiologists. Clinical factors, the percentage of heart volume receiving .5-60 Gy in increments of 5 Gy (V5-60, respectively), maximum heart dose and mean heart dose were analysed. Results: A total of 143 patients with oesophageal cancer were reviewed retrospectively. The median follow-up by CT was 15 months (range, 2.1-72.6 months) after RT. PCE developed in 55 patients (38.5%) after RT, and the median time to develop PCE was 3.5 months (range, 0.2-9.9 months). On univariate analysis, DVH parameters except for V60 were significantly associated with the development of PCE (p , 0.001). No clinical factor was significantly related to the development of PCE.Recursive partitioning analysis including all DVH parameters as variables showed a V10 cut-off value of 72.8% to be the most influential factor. Conclusion:The present results showed that DVH parameters are strong independent predictive factors for the development of PCE in patients with oesophageal cancer treated with CRT. Advances in knowledge: A heart dosage was associated with the development of PCE with radiation and without prophylactic nodal irradiation.

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Late Toxicity After Definitive Concurrent Chemoradiotherapy for Thoracic Esophageal Carcinoma

Cited by 100 publications

References 15 publications

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

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

The impact of radiation therapy sequencing on survival and cardiopulmonary mortality in the combined modality treatment of patients with esophageal cancer

Predictive factors for pericardial effusion identified by heart dose–volume histogram analysis in oesophageal cancer patients treated with chemoradiotherapy

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