Dose-Escalated Definitive Chemoradiotherapy With Intensity-Modulated Radiation Therapy Versus Esophagectomy In Locally Advanced Resectable Esophageal Squamous Cell Carcinoma

Abstract

defined as lack of failure within the 50% isodose line (ISL). Liver control is defined as lack of recurrence elsewhere within the liver, outside the 50% ISL. Results: Twenty-two patients with HCC were identified, and one patient was excluded due to not being treated with DTT-SBRT. Thus, 21 patients were analyzed. Median age at treatment was 74 (range 36 e 86). Median tumor size was 3.5 cm (range 1.3 e 6.5 cm), and median PTV volume was 119.4 cm 3. Baseline Child-Pugh Score (CPS) was A5/6 in 20 patients (95%), and B8 in 1 patient (5%). Median follow-up was 13.3 months (range 8.2 e 23.6). Actuarial local control was 100% at 1 year and at 2 years. Median time to failure elsewhere in the liver was 18.3 months. Liver control was 75% at 1 year, and 37% at 2 years. Overall survival was 91% at 2 years. In terms of acute toxicities within 3 months of DTT-SBRT, 18 patients (85.7%) did not have any changes in bilirubin or albumin. Grade 3 platelet toxicities occurred in 3/21 patients (14.3%). Three of 21 patients (14.3%) had an increase in CPS by 1 point from A5 to A6. One patient (4.8%) was treated as a bridge to transplant, and this individual had an increase in CPS by 2 points from B8 to B10. There were no grade 4 or 5 toxicities. Conclusion: DTT-SBRT using the VERO system resulted in PTV reduction and minimal acute toxicity, while achieving excellent local control. Most individuals failed elsewhere in the liver, emphasizing the need to spare as much normal liver as possible to allow further locoregional treatment options.