Comparative outcomes for three-dimensional conformal versus intensity-modulated radiation therapy for esophageal cancer

Abstract

Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P < 0.0001). Superior OS was also associated on MVA with stage I/II disease (HR 0.523; P = 0.010) and tumor length ≤5 cm (HR 0.567; P = 0.006). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6% + 4.3% vs 9% + 7.4%, P = 0.012) and on MVA with a decrease in objective grade ≥3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.

Radiation dose escalation by simultaneous modulated accelerated radiotherapy combined with chemotherapy for esophageal cancer: a phase II study

“…Regarding the radiation delivery technique, IMRT and IGRT were applied in this study as compared to conventional RT technique in INT0123. Although advanced RT techniques could provide more accurate and precise treatment delivery, it is still unclear whether these advantages would lead to improvements in local tumor control and overall survival [4, 19–21]. Nevertheless, phase III trials comprising stand-dose arm using modern RT technique are warranted.…”

Advances in Radiotherapy Management of Esophageal Cancer

“…Table 3 summarizes retrospective, largely single-institutional data of IMRT-based treatment for locally advanced EC [28,29,30,31]. The largest study to date from MD Anderson Cancer Center has examined 676 patients, 413 of which were treated with 3DCRT and 263 IMRT [26].…”

Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer

“…The authors found significantly improved overall survival and cardiac‐specific mortality for patients treated with IMRT, but no differences in distant disease recurrence rate, cancer‐specific survival, or pulmonary‐related deaths. However, another single‐institution data analysis found no difference in overall survival but only reduced short‐term toxicity for patients treated with IMRT . The benefit of IMRT, particularly in improving long‐term clinical outcomes, remains unclear.…”