Patterns of Failure Following Dose-escalated Chemoradiotherapy for Fluorodeoxyglucose Positron Emission Tomography Staged Squamous Cell Carcinoma of the Oesophagus

Effeney, Rachel; Shaw, Tristan B; Burmeister, Bryan; Burmeister, Elizabeth; Harvey, Jennifer A.; Mai, Gang; Thomas, Janine; Barbour, Andrew P.; Smithers, B. Mark; Pryor, David

doi:10.1016/j.clon.2018.06.011

Cited by 3 publications

(3 citation statements)

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“…31 Despite the negative findings of INT01232, a number of studies have suggested a potential benefit for dose escalation. [31][32][33] Local failure (without distant metastasis) rates of 39% in Group 1 patients (majority T3/4 and node positive) are promising and support a rationale to revisit dose escalation. A recent study in appropriately staged patients with PET/CT reported similar failure rates of 39% in patients treated with high dose dCRT.…”

Section: Discussionmentioning

confidence: 94%

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Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus

et al. 2020

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Background Patterns of failure following definitive CRT (dCRT) are different as compared to neoadjuvant chemoradiotherapy (NACRT) with increased locoregional failures documented with dCRT. Aim To document failure patterns in patients with esophageal carcinoma treated with neoadjuvant and definitive intent radiation strategies. Methods Subjects were 123 patients treated with two chemoradiotherapy strategies. Group 1 (n = 99) underwent dose escalated definitive chemoradiotherapy (dCRT), Group 2 (n = 24) received neoadjuvant chemoradiotherapy (NACRT) followed by surgery. Cumulative incidence of locoregional failure (LRF), local failure (LF), regional lymph node failure (RLNF), and distant metastasis (DM) were computed; differences between the groups was evaluated using log rank test. Univariable and multivariable predictors of failure were identified using Cox regression analysis. Results Cumulative LRF: 64% in Group 1 vs 35% in Group 2 (P = .050). Cumulative LF: 59% in Group 1 vs 12% in Group 2 (P = .000). Cumulative RLNF: 30% in Group 1 vs 24% in Group 2 (P = .592). Most common RLNF: mediastinum for both groups (6% vs 12.5%, respectively). Distant metastasis: 40.4% Group 1 vs 17% Group 2 (P = .129), predominantly lung (Group 1, 5%), and nonregional nodes (Group 2, 8.3%). Univariate analysis identified age ≤50, absence of concurrent chemotherapy, dose ≤50 Gy, and incomplete radiotherapy to predict higher odds of LRF and DM for Group 1; absence of comorbidities predicted for lower odds of LRF for Group 2. Age ≤50 predicted for higher odds of RNLR for Group 1, while absence of comorbidities predicted for lower odds of RNLR in Group 2. Multivariate analysis identified age ≤50, incomplete radiotherapy, and absence of concurrent chemotherapy to predict higher odds of LRF for Group 1. Age ≤50, absence of concurrent chemotherapy predicted higher odds of DM for Group 1. Absence of comorbidity predicted lower odds of LRF in Group 2. Conclusion LRF is common in both groups, with LF being predominant in dCRT as opposed to RNLF in NACRT. Age ≤50, absence of concurrent chemotherapy is a predictor of LRF and DM in dCRT.

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Section: Discussionmentioning

confidence: 94%

“…Despite the negative findings of INT01232, a number of studies have suggested a potential benefit for dose escalation 31‐33 . Local failure (without distant metastasis) rates of 39% in Group 1 patients (majority T3/4 and node positive) are promising and support a rationale to revisit dose escalation.…”

Section: Discussionmentioning

confidence: 99%

Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus

et al. 2020

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“…While some retrospective studies demonstrated a dose-response, recent randomized control trials failed to find a difference in outcomes[ 31 - 33 ]. The effect of dose escalation in optimizing cure rate may be more evident in those with early-stage SCC where the tumor is radiosensitive and the rate of distant metastasis is low[ 34 ]. Higher doses can be associated with increased normal tissue toxicity and hence focusing radiotherapy as much as possible to the tumor area is essential.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Be¹,

Khor²,

Joon³

et al. 2021

WJG

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BACKGROUND Image-guided radiotherapy (IGRT) has significantly improved the precision in which radiotherapy is delivered in cancer treatment. Typically, IGRT uses bony landmarks and key anatomical structures to locate the tumor. Recent studies have demonstrated the feasibility of peri-tumor fiducials in enabling even more accurate delineation of target and normal tissue. The use of gold coils as fiducials in gastrointestinal tumors has been extensively studied. However, placement requires expertise and specialized endoscopic ultrasound equipment. This article reports the long-term outcomes of using a standard gastroscopy to inject liquid fiducials for the treatment of oesophageal and gastric tumors with IGRT. AIM To assess the long-term outcomes of liquid fiducial-guided IGRT in a cohort of oesophageal and gastric cancer patients. METHODS A retrospective cohort study of consecutive adults with Oesophagogastric cancers referred for liquid fiducial placement before definitive/neo-adjuvant or palliative IGRT between 2013 and 2021 at a tertiary hospital in Melbourne, Australia was conducted. Up to four liquid fiducials were inserted per patient, each injection consisting of 0.2-0.5mL of a 1:1 mixture of iodized oil (Lipiodol; Aspen Pharmacare) and n-butyl 2-cyanoacrylate (Histoacryl ® ; B. Braun). A 23-gauge injector (Cook Medical) was used for the injection. All procedures were performed by or under the supervision of a gastroenterologist. Liquid fiducial-based IGRT (LF-IGRT) consisted of computer-assisted direct matching of the fiducial region on cone-beam computerised tomography at the time of radiotherapy. Patients received standard-IGRT (S-IGRT) if fiducial visibility was insufficient, consisting of bone match as a surrogate for tumor position. Radiotherapy was delivered to 54Gy in 30 fractions for curative patients and up to 45Gy in 15 fractions for palliative treatments. RESULTS 52 patients were referred for liquid fiducial placement within the study period. A total of 51 patients underwent liquid fiducial implantation. Of these a total of 31 patients received radiotherapy. Among these, the median age was 77.4 years with a range between 57.5 and 88.8, and 64.5% were male. Twenty-seven out of the 31 patients were able to have LF-IGRT while four had S-IGRT. There were no complications after endoscopic implantation of liquid fiducials in our cohort. The cohort overall survival (OS) post-radiotherapy was 19 mo (range 0 to 87 mo). Whilst the progression-free survival (PFS) post-radiotherapy was 13 mo (range 0 to 74 mo). For those treated with curative intent, the median OS was 22.0 mo (range 0 to 87 mo) with a PFS median of 14.0 mo (range 0 to 74 mo). Grade 3 complication rate post-radiotherapy was 29%. CONCLUSION LF-IGRT is feasible in 87.1% of patients undergoing liquid fiducial placement through standard gastroscopy injection technique. Our cohort has an o...

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Antineoplastics

2018

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Patterns of Failure Following Dose-escalated Chemoradiotherapy for Fluorodeoxyglucose Positron Emission Tomography Staged Squamous Cell Carcinoma of the Oesophagus

Cited by 3 publications

References 28 publications

Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus

Assessing failure patterns of radical intent radiation strategies in patients with locally advanced carcinoma of the esophagus

Long-term clinical outcomes of lipiodol marking using standard gastroscopy for image-guided radiotherapy of upper gastrointestinal cancers

Antineoplastics

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