Sequential boost of intensity‐modulated radiotherapy with chemotherapy for inoperable esophageal squamous cell carcinoma: A prospective phase II study

Abstract

Purpose: This prospective phase II study aimed to determine the efficacy and tolerability of sequential boost of intensity-modulated radiation therapy (IMRT) with chemotherapy for patients with inoperable esophageal squamous cell carcinoma (ESCC). Methods: Patients with histologically or cytologically proven inoperable ESCC were enrolled in this study (ChiCTR-OIC-17010485). A larger target volume for subclinical lesion was irradiated with 50 Gy, and then, a smaller target volume only including gross tumor was boosted to 66 Gy. The fraction dose was 2 Gy, and no elective node was irradiated. Concurrent and consolidation chemotherapy of fluorouracil (600 mg/m 2 , days 1-3) plus cisplatin (25 mg/m 2 , days 1-3) was administered every 4 weeks, for 4 cycles in total. The primary endpoint was 2-year progressionfree survival (PFS). Results: Eighty-eight patients were enrolled in this study. The median age was 65 years (range: 45-75 years), and 69 patients (78.4%) were men. With the median follow-up of 26 (range: 3-95) months, the 2-and 5-year PFS were 39.3% and 36.9%, respectively, and overall survival (OS) were 57.1% and 39.2%, respectively. Tumor stage and concurrent chemotherapy were independent OS predictors. Major acute adverse events were myelosuppression and esophagitis, most of which were grades 1-2.Nine percent and 2.3% of patients had grade 3 acute esophagitis and late esophageal strictures, respectively. Conclusions: Sequential boost to 66 Gy by IMRT with chemotherapy was safe and effective for inoperable ESCC. A randomized phase III study to compare with standard dose of 50 Gy is warranted. K E Y W O R D Schemoradiotherapy, esophageal squamous cell carcinoma, intensity-modulated radiotherapy

Racial and Ethnic Health Disparities in Delay to Initiation of Intensity-Modulated Radiotherapy

“…The benefits of intensity-modulated radiotherapy (IMRT) over standard radiotherapy (RT), including decreased acute and late toxicities, improved quality of life, and opportunities for dose escalation, have been demonstrated in many disease sites. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] As a result, IMRT is often the preferred modality for radiotherapy delivery. The implementation of IMRT can be more resource-intensive than standard three-dimensional conformal RT (3DCRT), requiring insurance prior authorization, complex treatment planning, and specialized medical physics and dosimetry support.…”

Induction Chemotherapy Followed by Chemoradiotherapy With or Without Consolidation Chemotherapy Versus Chemoradiotherapy Followed by Consolidation Chemotherapy for Esophageal Squamous Cell Carcinoma

“…Definitive chemoradiotherapy currently remains a treatment option for these patients who can to tolerate chemoradiation. Definitive chemoradiotherapy treatment options for ESCC include concurrent chemoradiotherapy (CCRT) ( 8 ), concurrent chemoradiotherapy followed by consolidation chemotherapy (CCRT-C) ( 9 – 11 ), induction chemotherapy followed by concurrent chemoradiotherapy (I-CCRT) ( 12 , 13 ), and sequential chemoradiotherapy (SCRT) ( 14 ). Studies have demonstrated that CCRT confers a survival benefit for locally advanced ESCC compared with SCRT ( 14 , 15 ).…”

Chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma: A retrospective analysis

“… 6 , 7 , 8 , 9 , 10 Cisplatin plus fluorouracil (PF) has become the conventional chemotherapy regimen since the RTOG85‐01 clinical trial. 6 However, toxicity limits the completion of concurrent chemotherapy, 11 and the disease failure rates remain high, necessitating more effective regimens. Several protocols have been explored, including fluorouracil plus leucovorin and oxaliplatin (FOLFOX), paclitaxel and fluorouracil (TF), and paclitaxel and carboplatin (TC) schemes, which did not show significant survival benefits.…”