Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer

Lin, Steven H.; Merrell, Kenneth W.; Shen, Jincheng; Verma, Vivek; Correa, Arlene M.; Wang, Lu; Thall, Peter F.; Bhooshan, Neha; James, Sarah; Haddock, Michael G.; Suntharalingam, Mohan; Mehta, Minesh P.; Liao, Zhongxing; Cox, James D.; Komaki, Ritsuko; Mehran, Reza J.; Chuong, Michael D.; Hallemeier, Christopher L.

doi:10.1016/j.radonc.2017.04.013

Cited by 89 publications

(64 citation statements)

References 14 publications

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“…This is consistent with a retrospective single-institution report of HD therapy being associated with more acute adverse effects and potentially suboptimal surgical conditions (23). Nevertheless, in light of studies demonstrating that advanced RT techniques may decrease adverse and postoperative events, further work must assess whether a decrease in dose has additive effects as well (24)(25)(26)(27)(28).…”

Section: Discussionsupporting

confidence: 83%

Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Haque¹,

Verma

Butler³

et al. 2018

J. Gastrointest. Oncol.

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Background: Neoadjuvant chemoradiotherapy (CRT) for locally advanced esophageal cancer (EC) may utilize a wide variety of RT doses, without clear consensus to date. This study evaluated national practice patterns between lower dose (LD) (40-41.4 Gy) or higher dose (HD) (50-50.4 Gy) therapy, in addition to differences in survival and postoperative events. Methods: The National Cancer Data Base (NCDB) was queried [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013] for patients with newlydiagnosed cT1a-T4aN0/N+M0 EC that received neoadjuvant CRT followed by esophagectomy. Conclusions: Although neoadjuvant LD CRT has been underutilized for EC in the United States, it is rising in more recent years. Dose did not significantly impact survival before or after propensity matching, nor did it independently predict for survival. Treatment at academic facilities independently correlated with higher survival, which has implications for patient counseling.

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Section: Discussionsupporting

confidence: 83%

Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Haque¹,

Verma

Butler³

et al. 2018

J. Gastrointest. Oncol.

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“…Welsh et al found that large‐spot IMPT for distal esophageal carcinoma also lowered the doses to bilateral lungs and liver compared to IMRT . More recently, a large, retrospective multi‐institutional study also demonstrated that proton beam therapy appeared to be more clinically advantageous compared with 3‐dimensionl conformal RT and IMRT in lowering the incidence of pulmonary and cardiac complications as well as the mean length of in‐hospital stay …”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of distal esophageal carcinoma plans for patients treated with small‐spot intensity‐modulated proton versus volumetric‐modulated arc therapies

Liu

Bhangoo

Sio

et al. 2019

J Applied Clin Med Phys

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Background Esophageal carcinoma is the eighth most common cancer in the world. Volumetric‐modulated arc therapy (VMAT) is widely used to treat distal esophageal carcinoma due to high conformality to the target and good sparing of organs at risk (OAR). It is not clear if small‐spot intensity‐modulated proton therapy (IMPT) demonstrates a dosimetric advantage over VMAT. In this study, we compared dosimetric performance of VMAT and small‐spot IMPT for distal esophageal carcinoma in terms of plan quality, plan robustness, and interplay effects. Methods 35 distal esophageal carcinoma patients were retrospectively reviewed; 19 patients received small‐spot IMPT and the remaining 16 of them received VMAT. Both plans were generated by delivering prescription doses to clinical target volumes (CTVs) on phase‐averaged 4D‐CT's. The dose‐volume‐histogram (DVH) band method was used to quantify plan robustness. Software was developed to evaluate interplay effects with randomized starting phases for each field per fraction. DVH indices were compared using Wilcoxon rank‐sum test. For fair comparison, all the treatment plans were normalized to have the same CTVhigh D95% in the nominal scenario relative to the prescription dose. Results In the nominal scenario, small‐spot IMPT delivered statistically significantly lower liver Dmean and V30Gy[RBE], lung Dmean, heart Dmean compared with VMAT. CTVhigh dose homogeneity and protection of other OARs were comparable between the two treatments. In terms of plan robustness, the IMPT and VMAT plans were comparable for kidney V18Gy[RBE], liver V30Gy[RBE], stomach V45Gy[RBE], lung Dmean, V5Gy[RBE], and V20Gy[RBE], cord Dmax and D0.03boldcboldm3, liver Dmean, heart V20Gy[RBE], and V30Gy[RBE], but IMPT was significantly worse for CTVhigh D95%, D2boldcboldm3, and D5%‐D95%, CTVlow D95%, heart Dmean, and V40Gy[RBE], requiring careful and experienced adjustments during the planning process and robustness considerations. The small‐spot IMPT plans still met the standard clinical requirements after interplay effects were considered. Conclusions Small‐spot IMPT decreases doses to heart, liver, and total lung compared to VMAT as well as achieves clinically acceptable plan robustness. Our study supports the use of small‐spot IMPT for the treatment of distal esophageal carcinoma.

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“…This is also true for the few patients receiving adjuvant RT alone; potentially, these patients may have tolerated surgery poorly, developed complications, and/or postoperative deconditioningall of which could be associated with no receipt of CT and/ or inferior postoperative OS. Nevertheless, in light of these numerous biases, addition of RT to adjuvant CT should still be considered judiciously on a case-by-case basis while weighing a balance of risks and benefits; to this extent, the increase in conformal RT modalities may help to attenuate toxicities and complications [33][34][35][36][37]. Additionally, it is unclear why patients treated with RT alone had an OS of only 22.2 months.…”

Section: Discussionmentioning

confidence: 99%

Management of pathologic node-positive disease following initial surgery for clinical T1-2 N0 esophageal cancer: patterns of care and outcomes from the national cancer data base

et al. 2017

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In the largest study to date evaluating patterns of care for pN + disease following resection of cT1-2N0 EC, a strikingly high proportion of patients were observed. Adjuvant treatment, ideally chemotherapy or chemoradiation, independently correlated with higher survival, and should be considered in able patients. Treatment at academic facilities also associated with higher survival, which has implications for patient counseling.

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Multi-institutional analysis of radiation modality use and postoperative outcomes of neoadjuvant chemoradiation for esophageal cancer

Cited by 89 publications

References 14 publications

Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Dosimetric comparison of distal esophageal carcinoma plans for patients treated with small‐spot intensity‐modulated proton versus volumetric‐modulated arc therapies

Management of pathologic node-positive disease following initial surgery for clinical T1-2 N0 esophageal cancer: patterns of care and outcomes from the national cancer data base

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