Postoperative Intensity-Modulated Radiotherapy Improved Survival in Lymph Node-Positive or Stage III Thoracic Esophageal Squamous Cell Carcinoma

Zhang, Wencheng; Liu, Xiao; Xiao, Zefen; Zhang, Hongxing; Chen, Dongfu; Feng, Qinfu; Zhou, Zongmei; Lv, Jima; Liang, Jun; Hui, Zhouguang; Wang, Lvhua; Yin, Wenwu; Cheng, Guangming; Sun, Kelin; Li, Xiangyang; Fang, Dekang; He, Jié

doi:10.1159/000375391

Cited by 32 publications

(55 citation statements)

References 21 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 1993, Fok and colleagues reported on fatal hemorrhage from gastric ulcer secondary to radiotherapy, which may have been due to the delivery of large fractional doses (3.5 Gy per fraction). Other studies have reported grade 1–2 hematological toxicity ranging from 23.7% to 34.0%, and radiation esophagitis at 13.7%–28.0% after PORT . In our study, a conventional radiation dose of 2 Gy was delivered.…”

Section: Discussionmentioning

confidence: 87%

See 1 more Smart Citation

Adjuvant radiotherapy for stage pN1M0 esophageal squamous cell carcinoma: Results from a Chinese two‐center study

Chen

Xiao

et al. 2019

Thoracic Cancer

Self Cite

View full text Add to dashboard Cite

Background Whether postoperative radiotherapy is beneficial in the treatment of esophageal squamous cell carcinoma with one or two regional lymph node (LN) metastases (pN1) after esophagectomy is uncertain. This study aimed to explore the effect of postoperative radiotherapy (PORT) on survival. Methods Propensity score‐matching (PSM) analysis was conducted to balance the two arms (surgery only [S] or surgery plus postoperative radiotherapy [PORT]). The survival rate was calculated by the Kaplan‐Meier method and analyzed using the log‐rank test. Results A total of 992 cases confirmed positive for one or two regional LN metastases were eligible. After PSM, 622 patients were reviewed. Each group consisted of 311 cases. The median follow‐up was 80.7 months. For the overall cohort, the one‐, three‐ and five‐year overall survival (OS) were 90.6%, 51.9% and 38.2%, respectively. Disease‐free survival (DFS) was 76.0%, 41.4% and 32.1%, respectively. The five‐year OS and DFS were 45.0% and 39.8% for PORT, which was significantly higher than the S group (31.3% and 24.2%, both P < 0.001). On subgroup analysis, PORT was associated with improved OS and DFS for patients with pathological stage pT3–4N1M0, compared with S group (five‐year OS 41.3% vs. 23.5%, P < 0.001; five‐year DFS 35.8% vs. 18.8%, P < 0.001). However, for pT1–2N1M0 patients, PORT did not benefit OS and DFS compared with S ( P = 0.063). Conclusions In summary, the addition of PORT after esophagectomy was associated with a statistically significant improvement in OS and DFS for patients with pathological one or two lymph‐node positive pathology, in particular for stage pT3–4N1M0 patients.

show abstract

Section: Discussionmentioning

confidence: 87%

“…Radiotherapy was initiated four to six weeks after surgery and performed according to procedures described previously . Patients received conventional, three‐dimensional conformal or intensity‐modulated radiation therapy.…”

Section: Methodsmentioning

confidence: 99%

Adjuvant radiotherapy for stage pN1M0 esophageal squamous cell carcinoma: Results from a Chinese two‐center study

Chen

Xiao

et al. 2019

Thoracic Cancer

Self Cite

View full text Add to dashboard Cite

show abstract

“…The available data indicates that postoperative radiotherapy could reduce locoregional recurrence and improve overall survival of ESCC patients. Furthermore, the major of studies suggested that the SCV areas should be included in prophylactic radiotherapy for patients with upper, middle, and lower thoracic EC (6,(11)(12)(13).…”

Section: Background: To Map Detail Distribution Of Metastatic Supraclmentioning

confidence: 99%

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

et al. 2016

View full text Add to dashboard Cite

Background: To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV).Methods: A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results: In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV. Conclusions: According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas. was the most common site of recurrence regardless of the tumor location. Even among patients with lower thoracic ESCC, the incidence of SCV LN recurrence was as high as 33.8%. Similar to finding of Wu and colleagues, Cai et al. (6) performed a study to investigate the patterns of regional LN recurrence after radical surgery for ESCC. The results showed that SCV areas were the most common site of recurrence, followed by mediastinal and abdominal areas. As such, several studies also indicated that the incidence of SCV LN recurrence was a common site of recurrence after radical surgery (range, 33.3% to 75.0%) (7-9). The available data indicates that postoperative radiotherapy could reduce locoregional recurrence and improve overall survival of ESCC patients. Furthermore, the major of studies suggested that the SCV areas should be included in prophylactic radiotherapy for patients with upper, middle, and lower thoracic EC (6,(11)(12)(13).However, delineating the SCV region lymph nodal clinical target volume (CTVn) for esophageal carcinoma remains a challenging task. Currently, data documenting the precise location of involved SCV region LN in esophageal carcinoma are scarce. It is desirable to define detailed involvement patterns in the SCV region, so that these areas can be better covered and treated with an adequate radiation dose. Here, we describe the distribution of SCV LN metastasis for esophageal carcinoma patient after surgery according to computed tomography (CT) imaging in our institution, then analyzed the anatomic distribution of SCV region LN to outline the spatial and probabilistic distributions of LN, and to provide data for an evidence-based approach to SCV region radiation therapy field design. Thus, we could minimize inconsistency of irradiation field and to achieve precise radiotherapy of the SCV region for postoperative radiotherapy. Methods Patient populationWe retrospectively reviewed the...

show abstract

“…Unlike preoperative radiotherapy, postoperative radiotherapy is based on the precise pathological stage and allows delivery of higher doses to high‐risk volumes and thus reduces toxicities. These advantages are also likely to result in long‐term survival benefits over esophagectomy alone in TESCC patient . Thus, postoperative radiotherapy is regarded as an important treatment choice in China.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, postoperative radiotherapy is regarded as an important treatment choice in China. However, previous studies investigating the efficacy of postoperative radiotherapy in TESCC have all been single‐institution studies and enrolled patients with various disease stages; the results therefore may not be generalizable to all TESCC patients . Furthermore, there have been no well‐designed prospective studies comparing the efficacy of preoperative vs postoperative radiotherapy in TESCC.…”

Section: Introductionmentioning

confidence: 99%

Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: Analysis of surveillance, epidemiology, and end results database

Ouyang

et al. 2018

Cancer Medicine

View full text Add to dashboard Cite

To determine the value of radiotherapy in addition to esophagectomy for stage II and III TESCC. We searched the Surveillance, Epidemiology, and End Results (SEER) database for all cases of stage II‐III TESCC. Patients were grouped as those receiving pre‐ or postoperative radiotherapy plus esophagectomy and those receiving esophagectomy alone. Overall survival (OS) and cancer‐specific survival (CSS) were compared between the groups. Among the 3292 patients, multimodality treatments (pre‐ or postoperative radiotherapy plus surgery) were more effective than surgery alone (5‐year, OS: 17.3% vs 7.9%; P < 0.001; CSS: 51.8% vs 34.9%; P < 0.001). Among the patients receiving multimodality treatments, multivariate analyses revealed stage to be the most significant prognostic factor for OS (II vs III, HR, 0.726; P < 0.001), but the sequence of radiotherapy and surgery was only of the marginal significance (pre‐ vs postoperative, HR, 0.875; P = 0.093). Preoperative radiotherapy provided significantly better survival than postoperative radiotherapy in stage III disease (5‐year, OS: 13.0% vs 11.0%, P < 0.04; CSS: 49.2% vs 31.7%, P < 0.003), but not in stage II disease (5‐year OS: 23.5% vs 21.0%, P = 0.519; CSS: 62.0% vs 53.4%, P = 0.075). Radiotherapy in addition to esophagectomy provides better outcomes than esophagectomy alone for in stage II‐III TESCC. Preoperative radiotherapy followed by surgery appears to be the optimal treatment strategy in stage III TESCC.

show abstract

Postoperative Intensity-Modulated Radiotherapy Improved Survival in Lymph Node-Positive or Stage III Thoracic Esophageal Squamous Cell Carcinoma

Cited by 32 publications

References 21 publications

Adjuvant radiotherapy for stage pN1M0 esophageal squamous cell carcinoma: Results from a Chinese two‐center study

Adjuvant radiotherapy for stage pN1M0 esophageal squamous cell carcinoma: Results from a Chinese two‐center study

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: Analysis of surveillance, epidemiology, and end results database

Contact Info

Product

Resources

About