Results of radiotherapy for inoperable locally advanced esophageal cancer

Okawa, Tomohiko; Kita, Midori; Tanaka, Makiko; Ikeda, Michio

doi:10.1016/0360-3016(89)90369-6

Cited by 96 publications

(47 citation statements)

References 13 publications

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“…Our analysis of all 592 patients indicated that the 5-year OS and PFS were 23.5% and 19.6% respectively, and the median OS and PFS were 20 months and 14 months, respectively. Our OS rates for IMRT and 3D-CRT are better than reported previously (5-year OS less than 10%) [3][4][5][6][7][8]. Dirix et al [16][17] confirmed that IMRT and 3D-CRT improved the survival of patients with head-and-neck cancer due to improved dosimetry.…”

Section: Discussionsupporting

confidence: 55%

“…Radiotherapy is usually given to patients with locally advanced esophageal cancer who have inoperable disease or who refuse surgery [2]. However, the 5-year survival rate from conventional 2-dimensional (2D) radiation therapy alone is less than 10% [3][4][5][6][7][8]. Worni et al [9] reported that the 5-year OS following definitive radiotherapy alone for treatment of esophageal carcinoma was 11.2%, and was 12.9% for stage IIA patients, 14.2% for stage IIB patients, and 9.1% for stage III patients.…”

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confidence: 99%

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Results and prognostic factors of 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for esophageal carcinoma

Tan¹,

Xiao²,

Zhang³

et al. 2015

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The aim of this study was to summarize the outcomes and prognostic factors of 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for esophageal carcinoma in our institute. Five hundred ninety-two patients received radiotherapy for esophageal carcinoma (123 with 3D-CRT, 469 with IMRT) from January 2002 to March 2012. Three hundred sixty patients received radiotherapy alone and 232 patients received radiotherapy and chemotherapy. The endpoints were overall survival (OS), progression-free survival (PFS). Kaplan-Meier analysis was used to calculate endpoints, the log-rank test for univariate analysis, and multivariate analysis to identify independent prognostic factors. The median follow-up time was 22.6 months and the median dose was 60 Gy. The 1-year OS, PFS were 65.3%, 52.1%; the 3-year OS, PFS were 34.0%, 28.0%; and the 5-year OS, PFS were 23.5%, 19.6%. The median OS was 20 months (95% CI: 17.9-22.1 months) and the median PFS was 14 months (95% CI: 11.8-16.2 months). Univariate analysis indicated that sex, N-stage, M-stage, TNM stage, radiotherapy dose, weight loss before treatment, smoking, and drinking affected OS and PFS (p < 0.05 for all). T-stage affected OS (p = 0.042), but no significant influence on PFS (p = 0.101). The independent prognostic factors for better OS and PFS were early clinical TNM stage, high radiotherapy dose, and female sex (p < 0.05 for all). The results of esophageal carcinoma patients treated with 3D-CRT and IMRT with or without chemotherapy were promising. Clinical TNM stage, radiotherapy dose and sex were the independent prognostic factors for OS and PFS.

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Section: Discussionsupporting

confidence: 55%

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confidence: 99%

Results and prognostic factors of 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for esophageal carcinoma

Tan¹,

Xiao²,

Zhang³

et al. 2015

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“…These included 58% grade 3, 26% grade 4, and 8% grade 5 (treatment-related death). The Minsky Advances in the management of esophageal cancer Marmara Medical Journal 2015; 28 (Special issue 1): [3][4][5][6][7][8][9][10] cumulative incidence of fistula was 18%/year and the crude incidence was 14%. Of the 6 treatment related fistulas, 3 were fatal.…”

Section: Dose Intensification With Brachytherapymentioning

confidence: 99%

Advances in the management of esophageal cancer

Minsky

2015

Marmara Medical Journal

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The management of clinical stage III and IVa esophageal cancer has evolved in the past 2 decades. Based on the Cross trial, neoadjuvant chemoradiation, followed by surgical resection has become standard. For medically inoperable, definitive chemoradiation is most commonly used. The standard radiation dose is 50.4 Gy although trials of doseescalation are ongoing. At the current time, there are no definitive biomarkers to predict response. Keywords:Esophageal cancer, Radiation therapy, Chemotherapy, Dose-escalation NONOPERATIVE THERAPY Radiation therapy aloneRadiation therapy alone is limited to palliation or for patients who are medically unable to tolerate chemotherapy. The 5-year survival rate for patients treated with conventional doses of radiation therapy alone is 0-10% [1-3]. In the radiation therapy alone arm of the RTOG 85-01 trial in which patients received 64 Gy at 2 Gy/day with conventional techniques, all patients were all dead of disease by 3 years [4,5] Dose intensification with brachytherapyBrachytherapy can be delivered by low or high dose rates and has previously been used as a boost following external beam radiation therapy or chemoradiation [7][8][9][10][11][12][13][14][15][16]. This technique is limited by the effective treatment distance. The primary isotope is 192Ir, which is usually prescribed to treat to a distance of 1 cm from the source. Therefore, as confirmed by pathologic analysis of treated specimens, any portion of the tumor which is >1 cm from the source will receive a suboptimal radiation dose [17].Retrospective and single institution trials suggest that there is no advantage of adding brachytherapy to external beam radiation. Chemoradiation plus brachytherapy was tested prospectively by the RTOG 92-07 trial. A total of 75 patients with cancers of the thoracic esophagus (92% squamous cell, 8% adenocarcinoma) received the RTOG 85-01 50 Gy chemoradiation regimen followed by a boost during cycle 3 of chemotherapy with either low dose rate or high dose rate intraluminal brachytherapy [22]. Due to low accrual the low dose rate option was discontinued and the analysis was limited to patients who received the high dose rate treatment. High dose rate brachytherapy was delivered in weekly fractions of 5 Gy during weeks 8, 9, and 10. Several patients developed fistulas and the fraction delivered at week 10 was discontinued. The complete response rate was 73%. With a median follow-up of only 11 months, local failure as the first site of failure was 27%. Acute toxicities were high. These included 58% grade 3, 26% grade 4, and 8% grade 5 (treatment-related death). The

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“…For instance, in the series of De-Ren, 184 of the 678 patients had stage IV disease (De-Ren, 1989). Overall, the 5-year survival rate for patients treated with conventional doses of radiation therapy alone is 0% to 10% (DeRen, 1989;Newaishy et al, 1982;Okawa et al, 1989). The use of radiation therapy as a potentially curative modality requires doses of at least 50 Gy at 1.8 to 2.0 Gy/fraction.…”

Section: Radiation Therapy Alonementioning

confidence: 99%