Patterns of failure and clinical outcomes of definitive radiotherapy for cervical esophageal cancer

Abstract

PurposeBecause of the scarcity of cervical esophageal cancer (CEC), data for this disease entity is limited. We aim to evaluate the outcomes, prognostic factors and failure patterns of CEC treated by contemporary radiotherapy (RT).MethodsWe retrospectively analyzed 86 CEC patients consecutively treated between 2007 and 2015 by definitive RT with or without concurrent chemotherapy. RT was mainly delivered with Intensity Modulated Irradiation Therapy (IMRT) or Volumetric-Modulated Arc Therapy (VMAT). Statistical analyses were performed on survival, prognostic factors and failure patterns.ResultsThe median follow-up time was 19.4 months. The 3-year overall survival (OS), local regional failure free survival (LRFFS), distant metastatic free survival (DMFS), and progression free survival (PFS) were 53.6%, 57.9%, 81.5% and 41.5%, respectively. Independent predictors for poorer OS were N stage, hoarseness and recurrent laryngeal nerve lymph node (RLN) involvement, and predictors for LRFFS were N stage and EQD2 (equivalent dose in 2 Gy fraction) to gross tumor volume (GTV), with ≥ 66Gy achieving local control of 94.7%. Patients receiving elective nodal irradiation (ENI) had better nodal regional control than those receiving involved field irradiation (IFI). 31 (36%) patients had treatment failure and 15 (17.4%), 8 (9.3%) and 14 (16.2%) patients had local, regional, and distant failure, respectively. 86.7% (13/15) local failures were within GTV, and supraclavicular region (62.5%, 5/8) was the most common regional failure site. No severe toxicities were observed.ConclusionsOur results seem to indicate that good locoregional control might be achieved for CEC with adequate radiation dose and treatment planning approaches.

<p>Mapping of Regional Failures After Definitive Radiotherapy in Patients with Locally Advanced Cervical Esophageal Carcinoma</p>

“…19 However, a study by Gkika et al (n = 55, CEC treated with CCRT) also suggested that a higher radiation dose (>60 Gy vs ≤60Gy) did not lead to better 5-year OS (24% vs 26%, p = 0.78). 16 In our previous study 27 including 97 patients with CEC who received doses of 95% PGTV 50-70 Gy (median 66 Gy) and 95% PTV 40-60 Gy (median 55 Gy) because of adverse reactions, we also arrived at the same conclusion as Cao et al 19 , that a higher 95% PGTV dose (≥66 Gy) improved the OS. While, in our current study, when the completed doses for 95% PGTV and 95% PTV were raised to 59.4-70 Gy (median 66 Gy) and 50-60 Gy (median 58 Gy) respectively, we could not confirm the beneficial effects of higher dose radiation (shown in Appendix Figure 1).…”

Dosimetric comparison between helical tomotherapy and intensity‐modulated radiotherapy for esophageal carcinoma

“…The most common failure pattern of concurrent chemoradiotherapy is local failure . Recurrences in the target region are extremely rare, and reduction of the incidence is largely dependent on adequate irradiation, which indicates to us that the greatest challenge of esophageal cancer radiotherapy is achieving an adequate dose to the gross tumor volume while minimizing toxicity to the surrounding critical normal tissues …”

Clinical significance of the distance between the cricoid cartilage and upper edge of the tumor using PET‑CT in cervical esophageal cancer

“…In previous studies, the 5-year survival rates of CESCC were reported to be 18–35% ( 8 , 23 , 24 ). These results are similar to those for thoracic esophageal cancer ( 3 – 5 ).…”