Advances in Radiotherapy Management of Esophageal Cancer

Verma, Vivek; Moreno, Amy C.; Lin, Steven H.

doi:10.3390/jcm5100091

Cited by 29 publications

(14 citation statements)

References 40 publications

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“…e ambiguous or contradictory results may be due to the lack of data concerning the potential value of IMRT in a dose-escalated radiotherapy setting. e authors point out that this will become an important issue and challenge for the future, if the use of IMRT for EC gradually increases [23]. According to the univariate analysis results of the present study, the "without chemotherapy" was found to be a statistically significant risk factor for EC, showing that IMRT and chemotherapy could together prolong overall survival.…”

Section: Discussionsupporting

confidence: 44%

Comparison between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Their Effectiveness in Esophageal Cancer Treatment: A Retrospective Single Institution Study

Bai

Dang

Chen

et al. 2020

Journal of Oncology

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Although a large number of influential studies that have been conducted worldwide on locally advanced esophageal cancer (EC) have employed the treatment modality of three-dimensional conformal radiotherapy (3D-CRT), an advanced as well as highly conformal technology known as intensity-modulated radiotherapy (IMRT) has attracted increasing attention from the radiotherapy research community. This is because of the clear advantages of IMRT, including decrease in radiation dose that reaches critical cardiopulmonary organs. These two treatment modalities need to be investigated with regard to their effect on local control rate and patient survival. In addition, related clinical factors also need to be explored. Data from a total of 431 patients with locally advanced EC, who underwent radiation therapy between January 1, 2010 and December 31, 2013, were included in the present study. Two hundred and ninety-three patients received 3D-CRT, while 138 patients received IMRT. We constructed propensity score matches to make the two groups be comparable (136 patients in 3D-CRT group and 138 patients in IMRT group. Kaplan–Meier analysis was conducted to evaluate the endpoint of overall survival (OS). A Cox proportional hazards model was employed to analyze the relationship between the associated factors and the outcomes via univariate and multivariate approaches. The mean follow-up period was 36.2 months, and the median follow-up period was 23 months. For the IMRT group, the median OS was 31 months, and the 1-, 3-, and 5-year OS rates were 70.3%, 50.0%, and 42.8%, respectively, while for the 3D-CRT group, the median OS was 22 months, and the 1-, 3-, and 5-year OS rates were 63.2%, 41.0%, and 35.4%, respectively (p<0.05). The univariate analysis revealed that quit drinking, chemotherapy, and concurrent chemotherapy were significant risk factors for the prognosis of EC (p<0.05), as well as the radiation therapy technique used (p=0.052). The multivariate analysis indicated that chemotherapy and quit drinking were independent predictive factors for OS. OS is found to be significantly better in the IMRT group, compared with that of the 3D-CRT group. Even though these outcomes need further validation, IMRT should be considered preferentially as a therapeutic option for EC, in combination with chemotherapy and persuading patients to quit drinking.

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Section: Discussionsupporting

confidence: 44%

Comparison between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Their Effectiveness in Esophageal Cancer Treatment: A Retrospective Single Institution Study

Bai

Dang

Chen

et al. 2020

Journal of Oncology

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“…Nevertheless, the value of such an analysis is not diminished, because there is still a lack of data regarding the potential value of IMRT in the definitive, relatively dose-escalated setting. This will undoubtedly be an important issue in the coming years as the use of IMRT for EC increases [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated versus 3-dimensional conformal radiotherapy in the definitive treatment of esophageal cancer: comparison of outcomes and acute toxicity

et al. 2017

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BackgroundThough the vast majority of seminal trials for locally advanced esophageal cancer (EC) utilized three-dimensional conformal radiotherapy (3DCRT), the advanced and highly conformal technology known as intensity-modulated radiotherapy (IMRT) can decrease doses to critical cardiopulmonary organs. To date, there have been no studies comparing both modalities as part of definitive chemoradiation (dCRT) for EC. Herein, we investigated local control and survival and evaluated clinical factors associated with these endpoints between cohorts.MethodsWe retrospectively analyzed 93 patients (3DCRT n = 49, IMRT n = 44) who received dCRT at our institution between 2000 and 2012 with the histologic diagnosis of nonmetastatic EC, a Karnofsky performance status of ≥70, curative treatment intent, and receipt of concomitant CRT. Patients were excluded if receiving <50 Gy. Kaplan-Meier analysis was used to evaluate the endpoints of local relapse rate (LR), progression-free survival (PFS), and overall survival (OS). Cox proportional hazards modeling addressed factors associated with outcomes with univariate and multivariate approaches. Rates of acute toxicities and basic dosimetric parameters were compared between 3DCRT and IMRT patients.ResultsMean follow-up was 34.7 months. The 3-year LR was 28.6% in the 3DCRT group and 22.7% in the IMRT group (p = 0.620). Median PFS were 13.8 and 16.6 months, respectively (p = 0.448). Median OS were 18.4 and 42.0 months, respectively (p = 0.198). On univariate analysis, only cumulative radiation dose was associated with superior LR (hazard ratio (HR) 0.736; 95% confidence interval (CI) 0.635 – 0.916, p = 0.004). Factors clearly affecting survival were not observed.ConclusionsWhen comparing 3DCRT- versus IMRT-based dCRT, no survival benefits were observed. However, we found a lower local recurrence rate in the IMRT group potentially owing to dose-escalation. Prospective data are needed to verify the presented results herein.

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“…This is also true for the few patients receiving adjuvant RT alone; potentially, these patients may have tolerated surgery poorly, developed complications, and/or postoperative deconditioningall of which could be associated with no receipt of CT and/ or inferior postoperative OS. Nevertheless, in light of these numerous biases, addition of RT to adjuvant CT should still be considered judiciously on a case-by-case basis while weighing a balance of risks and benefits; to this extent, the increase in conformal RT modalities may help to attenuate toxicities and complications [33][34][35][36][37]. Additionally, it is unclear why patients treated with RT alone had an OS of only 22.2 months.…”

Section: Discussionmentioning

confidence: 99%

Management of pathologic node-positive disease following initial surgery for clinical T1-2 N0 esophageal cancer: patterns of care and outcomes from the national cancer data base

et al. 2017

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In the largest study to date evaluating patterns of care for pN + disease following resection of cT1-2N0 EC, a strikingly high proportion of patients were observed. Adjuvant treatment, ideally chemotherapy or chemoradiation, independently correlated with higher survival, and should be considered in able patients. Treatment at academic facilities also associated with higher survival, which has implications for patient counseling.

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Advances in Radiotherapy Management of Esophageal Cancer

Cited by 29 publications

References 40 publications

Comparison between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Their Effectiveness in Esophageal Cancer Treatment: A Retrospective Single Institution Study

Comparison between Intensity-Modulated Radiotherapy and Three-Dimensional Conformal Radiotherapy for Their Effectiveness in Esophageal Cancer Treatment: A Retrospective Single Institution Study

Intensity-modulated versus 3-dimensional conformal radiotherapy in the definitive treatment of esophageal cancer: comparison of outcomes and acute toxicity

Management of pathologic node-positive disease following initial surgery for clinical T1-2 N0 esophageal cancer: patterns of care and outcomes from the national cancer data base

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