Simultaneous integrated boost concepts in definitive radiation therapy for esophageal cancer: outcomes and toxicity

Abstract

Background Radiation therapy and chemoradiation therapy play a major role in the definitive management of esophageal cancer. Survival in esophageal cancer patients is still relatively poor, mostly due to high rates of local recurrence and distant metastases. It is hypothesized that dose escalation in radiotherapy could improve outcomes. Therefore, this retrospective analysis aimed to investigate the outcomes and toxicity in patients treated with local dose escalation by means of using simultaneous integrated boost concepts. Methods Between 2012 and 2018, 101 patients with esophageal carcinoma were analyzed in this monocentric, retrospective study. All patients received definitive chemoradiation or radiation therapy alone as intensity modulated radiotherapy. The prescribed dose was 50.4 Gy in 28 fractions to the primary tumor and the elective lymph nodes as well as a simultaneous integrated boost (SIB) with 58.8 Gy to macroscopic tumor and lymph node metastases. Endpoints were overall survival (OS), progression free survival (PFS), local control rate (LCR) and toxicity. Results 60 patients (59.4%) received chemoradiation, 41 patients (40.6%) radiotherapy alone. The median follow up was 17 months (range 0–75 months). OS, PFS and LCR were at 63.9%, 53.9% and 59.9% after 1 year and 37.6%, 34.5% and 36.1%, respectively after 3 years. 16 patients (15.8%) in total developed a locoregional recurrence within the field of radiation. In 48 patients (47.5%) at least one grade III° (CTCAE) toxicity was documented during radiotherapy, mostly dysphagia (36 pat., 75%). One patient suffered from a grade IV° pneumonia. Conclusion This retrospective analysis demonstrates that a SIB concept in definitive (chemo)radiation therapy is safe and feasible, showing acceptable outcomes in this patient cohort. Considering that this cohort mainly consists of elderly patients not eligible for chemotherapy in many cases, we emphasize the aspect of SIB radiation therapy as potential partial compensation for omitted simultaneous chemotherapy. Prospective studies are needed for validation.

Efficacy and Prognostic Analysis of 315 Stage I–IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy

“…The 1-year and 3-year OS rates in our study were 75.2% and 40.2%, respectively, which were substantially higher than those reported by Ristau et al (63.9% and 37.6% respectively). 8 This result is in line with the findings of Xu et al, 9 but considerably lower than the 3- and 5-year survival rates of 53% and 44% and the median survival time of 43.2 months with IMRT reported by Lin et al 10 A possible explanation for this difference is that only 76.5% of the patients received CCRT in our study.…”

Neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma: does everyone need it?

“…J. Ristau et al, (2021) [20] announced 72.3 % of grade 3 acute toxicity, whereas only 47.5 % of cases were manageable; concomitant chemotherapy had to be interrupted or terminated in 19.8 %. Obviously, intolerable toxicity may worsen the patient's performance status and reduce the number of candidates for scheduled surgery.…”

Approach to Localized Squamous Cell Cancer of the Esophagus

“…The authors concluded IMRT use in definitive CRT/RT is safe and feasible, with acceptable survival rates and moderate toxicity. Prospective studies are needed [ 40 ].…”