Feasibility of Involved-Field Conformal Radiotherapy for Cervical and Upper-Thoracic Esophageal Cancer

Ma, Jizhen; Song, Yipeng; Yu, Jinming; Zhou, Wei; Cheng, Er-Cheng; Zhang, Xiqin; Kong, Li

doi:10.1159/000334194

Cited by 51 publications

(61 citation statements)

References 13 publications

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“…Zhao et al 8 reported rates of grade 3 acute and late toxicities of 9% and 6% respectively after ifi, and no patients experienced acute or late grade 4 or 5 toxicities. Ma et al 21 reported significant differences between ifi and eni groups with respect to hematologic toxicity, infection, and vomiting. Those results appear promising, because treatment-related toxicities were less severe than those observed in trials using an extended field.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, the rationale for use of eni is to prevent regional nodal relapse rather than to improve survival. In a prospective randomized trial, Ma et al 21 compared eni with ifi in patients with cervical and upper thoracic eca, observing no significant difference in the 3-year os or locoregional control rate between the ifi and eni groups (32.0% and 80.1% vs. 41.3% and 85.7% respectively). Liu et al 22 noted that out-of-field regional cervical node metastasis occurred in 8% of the ifi group and 10% of the eni group in patients with cervical and upper thoracic eca.…”

Section: Discussionmentioning

confidence: 99%

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Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Zhao

Zhang

et al. 2016

Current Oncology

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Objectives Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus.Methods Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time.Results In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively. ConclusionsFor patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Zhao

Zhang

et al. 2016

Current Oncology

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“…However, data from esophageal squamous cell cancer has generated controversy regarding the effectiveness of an expanded CTV in preventing either local recurrence or LNM, and it is unclear whether such large and standardized fields are always necessary, including for esophageal adenocarcinomas [7][8][9]. A more tailored CTV limited to nodal stations at significant risk could reduce adverse effects of RT, but data are lacking to guide the choice of which lymph node regions to include, particularly for distal esophageal adenocarcinomas.…”

Section: Introductionmentioning

confidence: 99%

Distribution of FDG-avid nodes in esophageal cancer: Implications for radiotherapy target delineation.

Garcia

Goodman

Cambridge

et al. 2015

JCO

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Purpose: Clinical target volumes (CTV) for radiotherapy (RT) in esophageal cancer (EC) are based on standard expansions of primary tumor volume. Data is needed to define regions at highest risk for occult disease, based on histology and location of the primary tumor. We therefore reviewed PET scans in EC patients to characterize the location of FDG-avid lymph node metastases (LNM). Materials and methods: We identified 473 EC patients with reviewable pre-treatment PET-CT scans. Tumors were classified by histology and location; 85% were distal or GE junction tumors and 71% were adenocarcinoma. FDGavid LNM were classified using standard radiographic nodal atlases, and distances from primary tumor to paraesophageal LNM were also measured. Results: The most common LNM in upper EC were supraclavicular, retrotracheal and paratracheal. The most common LNM in lower EC were paraesophageal and in the gastrohepatic space. Overall, 55% of paraesophageal LNM were adjacent to primary tumor. Of upper esophageal tumors with paraesophageal LNM, 87% were adjacent to the tumor and none were >6 cm from tumor. However, 57% of lower esophageal tumors with paraesophageal LNM had non-adjacent paraesophageal nodes, 24% of which were >8 cm from the tumor. Conclusion: A more data-driven and individualized approach to CTV delineation could improve the therapeutic ratio of RT in esophageal cancer. These results can guide CTV delineation by indicating the potential distribution of nodal involvement in esophageal cancer.

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“…However, certain studies demonstrated that, in patients who underwent radiotherapy rather than ENI, the lymph node recurrence rate outside the field was 2-8% (7,8). A number of studies in China and abroad also demonstrated that, compared with ENI, the toxicity of which was considered acceptable for the majority of the patients, the recurrence rate and distant metastasis in patients treated with IFI was not notably increased (4,13,14). Therefore, regarding patients treated with IFI, it remains unclear how they should be irradiated in order to control the recurrence of regional lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

“…Over the last few years, an increasing number of studies have been conducted on elective nodal irradiation (ENI) for esophageal cancer; however, their conclusions have been inconsistent. It was previously reported that, compared with involved-field irradiation (IFI), ENI does not improve the local control rate or long-term survival of patients with esophageal cancer (4). Previous studies have indicated that ENI may prevent regional lymph node metastasis (5,6), whereas other studies (7)(8)(9) reported that the isolate out-of-field nodal failure rate was low and overall survival did not decrease when IFI was used (6,7).…”

Section: Introductionmentioning

confidence: 99%

Radiation dose to the lymph drainage area in esophageal cancer with involved-field irradiation

et al. 2015

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Abstract. The aim of this study was to quantify the radiation dose to the corresponding lymph drainage area in esophageal cancer using three-dimensional conformal radiation therapy (3D-CRT) with involved-field irradiation (IFI) and to analyze associated factors. A retrospective analysis of 81 patients with esophageal cancer was conducted. According to the location of the lesions, the lymph drainage area was delineated and the dosimetric parameters were calculated. The 1-, 3-, 5-and 8-year survival rates of the patients were 67.90, 33.33, 20.99 and 11.11%, respectively. Based on the dose-volume histogram in the treatment plan, we calculated the volume percentage of the planning target volume including clinically positive lymph nodes (PTV-N) receiving radiation doses of 30, 35, 40, ). The median values of V PTV-N30-50 were 73, 70, 67, 64 and 58%, respectively. The prescribed dose size exhibited no correlation with V PTV-N30-35 , but did exhibit a significant correlation with V PTV-N40-50 ; the radiation field was not correlated with V PTV-N30-45 , but exhibited a significant correlation with V PTV-N50 ; the length of the lesion on esophageal barium meal X-ray and the PTV were significantly correlated with V PTV-N30-50 . The analysis of variance revealed that the V PTV-NX value in the upper thoracic segment was higher compared with that in the middle and lower thoracic segments; V PTV-N30-35 values differed significantly according to the different locations of the lesions, whereas V PTV-N40-50 values exhibited no significant differences. The value of V PTV-NX exerted no significant effect on long-term patient survival. Therefore, the corresponding lymph drainage area of esophageal cancer is subjected to a certain radiation dose when patients undergo 3D-CRT with IFI, which may play a role in the prevention of regional nodal metastasis. However, this hypothesis requires confirmation by further clinical studies. IntroductionThere is significant controversy regarding target region delineation by esophageal cancer radiotherapy in different regions. In the RTOG85-01 randomized trial (1), irradiation of the entire esophagus for esophageal cancer was recommended. In the RTOG94-05 trial (2), an area with a margin of 2-5 cm surrounding the gross tumor volume (GTV) was defined as the clinical target volume (CTV). The supraclavicular nodes were included only when the tumor was located in the cervical esophageal area. However, the results of these two trials were not satisfactory, as the survival and local control rates did not improve significantly. In the RTOG01-33 trial (3), three-dimensional conformal radiation therapy (3D-CRT) technology was applied. The CTV included a 3-cm margin around the GTV, while the planning target volume (PTV) included a margin of ≤2 cm around the CTV. Over the last few years, an increasing number of studies have been conducted on elective nodal irradiation (ENI) for esophageal cancer; however, their conclusions have been inconsistent. It was previously reported that, compared with involved-field ...

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Feasibility of Involved-Field Conformal Radiotherapy for Cervical and Upper-Thoracic Esophageal Cancer

Cited by 51 publications

References 13 publications

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Distribution of FDG-avid nodes in esophageal cancer: Implications for radiotherapy target delineation.

Radiation dose to the lymph drainage area in esophageal cancer with involved-field irradiation

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