Primary Radiotherapy Compared With Primary Surgery in Cervical Esophageal Cancer

Cao, Chenzhong; Luo, Jing; Gao, Li; Xu, Gezhi; Yi, Jun; Huang, Xinghe; Li, Su Yan; Xiao, Jian; Liu, Shao Yan; Xu, Zhen; Tang, Ping

doi:10.1001/jamaoto.2014.2013

Cited by 44 publications

(38 citation statements)

References 20 publications

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“…These series were heterogeneous in terms of RT techniques, CHT regimens, and radiation doses. Approximately 59% of patients within these reports [6, 13, 15, 19, 26–28] received RT alone, and 41% received CRT [7, 13, 14, 16, 19, 26–29]. When a concurrent treatment approach was chosen, 22% of these patients received ICHT [16, 20, 29].…”

Section: Discussionmentioning

confidence: 99%

Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study

et al. 2017

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ObjectiveTo report oncological outcomes and toxicity rates, of definitive platin-based chemoradiadiationtherapy (CRT) in the management of proximal esophageal cancer.MethodsWe retrospectively reviewed the medical records of patients with cT1-4 cN0-3 cM0 cervical esophageal cancer (CEC) (defined as tumors located below the inferior border of the cricoid cartilage, down to 22 cm from the incisors) treated between 2004 and 2013 with platin–based definitive CRT in four Swiss institutions. Acute and chronic toxicities were retrospectively scored using the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 4.0 (CTCAE-NCI v.4.0). Primary endpoint was loco-regional control (LRC). We also evaluated overall survival (OS) and disease-free survival (DFS) rates. The influence of patient- and treatment related features have been calculated using the Log-rank test and multivariate Cox proportional hazards model.ResultsWe enrolled a total of 55 patients. Median time interval from diagnosis to CRT was 78 days (6–178 days). Median radiation dose was 56Gy (28–72Gy). Induction chemotherapy (ICHT) was delivered in 58% of patients. With a median follow up of 34 months (6–110months), actuarial 3-year LRC, DFS and OS were 52% (95% CI: 37–67%), 35% (95% CI: 22–50%) and 52% (95% CI: 37–67%), respectively. Acute toxicities (dysphagia, pain, skin-toxicity) ranged from grade 0 – 4 without significant dose-dependent differences. On univariable analyses, the only significant prognostic factor for LRC was the time interval > 78 days from diagnosis to CRT. On multivariable analysis, total radiation dose >56Gy (p <0.006) and ICHT (p < 0.004) were statistically significant positive predictive factors influencing DFS and OS.ConclusionDefinitive CRT is a reliable therapeutic option for proximal esophageal cancer, with acceptable treatment related toxicities. Higher doses and ICHT may improve OS and DFS and. These findings need to be confirmed in further prospective studies.

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Section: Discussionmentioning

confidence: 99%

Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study

et al. 2017

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“…The 5‐year overall survival rate for esophageal cancer was only 12.8% from 1998 to 2007 in Taiwan . The management of carcinoma arising in the cervical or esophagogastric junction is very different from that of thoracic esophageal SCC (TESCC) . The management of cervical esophageal cancer is more closely related to the management of head and neck SCC than that of malignancies involving the more distal portions of the esophagus.…”

Section: Introductionmentioning

confidence: 99%

“…The management of cervical esophageal cancer is more closely related to the management of head and neck SCC than that of malignancies involving the more distal portions of the esophagus. Concurrent chemoradiotherapy (CCRT) is preferred over surgery in patients who have cervical esophageal cancer, because survival appears to be the same with both treatments, and major morbidity is avoided in most patients . By contrast, complete surgical resection is the first treatment choice in the management of cancer of the esophagogastric junction .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma receiving definitive radiotherapy or concurrent chemoradiotherapy through intensity‐modulated radiation therapy techniques

Yen

Chang

Wei

et al. 2017

Cancer

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“…Due to its anatomical location, CEC often invades adjacent structures, including hypopharynx, thyroid gland, recurrent laryngeal nerves lymph node (RLN) and thoracic esophagus which are poor prognostic features. The optimal treatment approaches using either surgical or non-surgical approach is still controversial [3, 4]. Despite progress made using modern surgical techniques, significant postoperative complications remain, with a negative impact on the patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

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

Zhao

Zhou

et al. 2017

Oncotarget

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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.

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Primary Radiotherapy Compared With Primary Surgery in Cervical Esophageal Cancer

Abstract: Given the similarities in rates of local FFS, regional FFS, distant FFS, and overall survival between the primary RT and primary surgery CEC treatment groups, we recommend primary RT for larynx preservation, with surgery offered subsequently for patients who do not respond to RT.

Cited by 44 publications

References 20 publications

Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study

Outcome of proximal esophageal cancer after definitive combined chemo-radiation: a Swiss multicenter retrospective study

Effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma receiving definitive radiotherapy or concurrent chemoradiotherapy through intensity‐modulated radiation therapy techniques

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

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