Comparison of intensity-modulated radiotherapy vs 3-dimensional conformal radiotherapy for patients with non-metastatic esophageal squamous cell carcinoma receiving definitive concurrent chemoradiotherapy

Abstract

Whether the survival outcome of patients with non-metastatic esophageal squamous cell carcinoma (NM-ESCC) receiving definitive concurrent chemoradiotherapy (CCRT) is better with intensity-modulated radiotherapy (IMRT) or with 3-dimensional conformal radiotherapy (3DCRT) has been debated in the literature. We designed this population-based propensity-score (PS)-matched analysis to address this question. We identified eligible patients diagnosed between 2008 and 2015 from the Taiwan Cancer Registry and constructed a PS-matched cohort (1:1 for IMRT vs 3DCRT) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT and 3DCRT during the entire follow-up period. We also evaluated freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Sensitivity analyses (SA) were performed to examine the robustness of our findings. Our study population constituted 558 patients who were well balanced with regard to the measured covariables. The HR of death with IMRT compared to 3DCRT was 0.43 (95% confidence interval 0.35-0.52, P < .001). The results remained significant for FFLRR and ECSS. In SA, our results remained significant when additional covariables were taken into consideration. The survival outcome of patients with NM-ESCC receiving CCRT might be better with IMRT vs 3DCRT. These study results should be interpreted with caution given some possible covariates lacking in the registry. Further studies are needed to clarify this issue.

Increased dose of re-irradiation therapy improves the survival of patients with local recurrent esophageal squamous cell carcinoma after radiotherapy

“…More than two-thirds of patients with hematological toxicity or gastrointestinal reaction received chemoradiotherapy. In this study, the incidence of radiation pneumonitis was lower than that shown in previous studies [25]. In addition, grade 1-2 radiation pneumonitis occurred in six (10.3%) and eight (11.9%) patients in the LD and HD groups, respectively, with controllable symptoms.…”

Increased dose of re-irradiation therapy or combined chemotherapy to improve survival of local recurrent esophageal squamous cell carcinoma after radiotherapy

“…Hematological toxicity and gastrointestinal reactions were also common, and only hematologic toxicity was signi cant between the two groups. In this study, the incidence of radiation pneumonitis was lower than in previous studies [19]. Grade 1-2 radiation pneumonitis occurred in six (10.3%) and eight (11.9%) patients in the LD and HD groups, respectively, and the symptoms was controllable.…”

Definitive Radiation Therapy With Dose Escalation Is Beneficial For Patients With Squamous Cell Cancer Of The Esophagus

“…In the present report, grade 3 non-hematological or hematological toxicities were an infrequent occurrence; however, complete data on chronic toxicity was unavailable for a detailed analysis. Advances in delivery techniques have also led to further decrease in treatment related toxicities and reduced potential for marginal misses thereby improving both compliance and local control (6,29). Concurrent chemotherapy had a significant impact on DFS and OS on univariate analysis, but not on multivariate analysis, possible because of multi-collinearity with other unadjusted correlated variables.…”