Long-term Clinical Outcome of Intensity-modulated Radiation Therapy for Locally Advanced Esophageal Squamous Cell Carcinoma

Ge, Xiaolin; Yang, Xi; Lü, Xiaobo; Wen, Wei; Zhen, Fuxi; Ye, Hongxun; Zhu, Hongcheng; Cao, Yukun; Zhang, Sheng; Cheng, Hongyan; Ma, Jianxin; Yang, Baixia; Dai, Shengbin; Guo, Qing; Cai, Jing; Sun, Xinchen

doi:10.5301/tj.5000234

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…We investigated the safety of high-dose HT for medically inoperable esophageal cancer that is unable to tolerate chemoradiotherapy or surgical resection. In our study, the 2year OS rate was 46.9%, which is similar to the previous reports of patients treated with 3D-CRT and IMRT [7,8]. In addition, the bilateral lung V5 was 61.7%, V20 was14.6%, the average dose for the heart was 21.5 Gy, and the maximum dose for the spinal cord was 34.0 Gy.…”

Section: Discussionsupporting

confidence: 89%

“…In recent years, advanced radiotherapy techniques such as IMRT, VMAT, and HT have been used, and the cumulative dose in adjacent normal organs can be significantly reduced [2,3]. Ge et al reported IMRT using a linear accelerator in patients with locally advanced esophageal cancer [8]. The 1-and 3-years OS rates for patients treated with IMRT alone were 69.64% and 37.50%, respectively, and 1-and 3-years OS rates for patients treated with concurrent chemoradiotherapy and IMRT were 87.50% and 57.14%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Initial experience of high-dose helical tomotherapy for medically inoperable esophageal cancer patients

2020

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Purpose: Helical tomotherapy (HT) is one of the radiotherapy methods that has become widespread in recent years. The aim of this study is to investigate the safety of high-dose HT for medically inoperable esophageal cancer that is unable to tolerate chemoradiotherapy. Methods: Eight patients with medically inoperable esophageal squamous cell carcinoma who cannot tolerate chemoradiotherapy were irradiated to 60 Gy at 2 Gy/fraction with HT. Results: The 1-, and 2-year overall survival rate were 75.0%, and 46.9%, respectively. The 1-, and 2-year locoregional recurrence-free survival rate ware 72.9%, and 72.9%, respectively. Three patients developed grade 2 or 3 hematological acute toxicity, and one patient developed grade 2 late pericardial effusion. Conclusions: Medically inoperable patients with esophageal cancer who cannot tolerate chemoradiotherapy might be treated safely by high-dose HT with minimal adverse events.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Initial experience of high-dose helical tomotherapy for medically inoperable esophageal cancer patients

2020

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“…ere are several trials that evaluate the use of IMRT for the treatment of EC. e effectiveness and safety of IMRT for locally advanced esophageal squamous cell carcinoma (ESCC) had been evaluated by Ge et al with the study having reported that IMRT was a practical and feasible technique for the treatment of ESCC [18]. Zhang et al found that postoperative IMRT could reduce local recurrence, as well as improve survival of lymph node-positive or stage III thoracic esophageal squamous cell carcinoma (TESCC) patients [19].…”

Section: Discussionmentioning

confidence: 99%

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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“…Although the sample size of this study was small and only included 26 cases of squamous cell carcinoma (SCC), it was instructive for further studies. The most common pathological type of EC in China is SCC, and radiotherapy is administered with a total dose of 60-66 Gy [21]. This range was much higher than the dose used in the standard treatment of OC via conventional fractionated radiotherapy (50.4 Gy).…”

Section: Introductionmentioning

confidence: 99%

Imaging biomarkers of contrast-enhanced computed tomography predict survival in oesophageal cancer after definitive concurrent chemoradiotherapy

Zeng

Zhai

Chen

et al. 2020

Preprint

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Background: This study aimed to evaluate the predictive potential of contrast-enhanced computed tomography (CT)-based imaging biomarkers (IBMs) for the treatment outcomes of oesophageal squamous cell carcinoma (OSCC) patients after definitive concurrent chemoradiotherapy (CCRT). Methods: Altogether, 154 patients with OSCC who underwent definitive CCRT were included in this retrospective study. All patients were separated randomly to a training cohort (n=99) and the validation cohort (n=55). Pre-treatment contrast-enhanced CT scans were obtained for all patients and used for the extraction of IBMs. An IBM score was constructed by using the least absolute shrinkage and selection operator with Cox regression analysis in the training cohort and tested in the validation cohort. IBM nomograms were built based on IBM scores for individualized survival estimation. Finally, a decision curve analysis was performed to estimate the clinical usefulness of the nomograms. Results: Altogether, 96 IBMs were extracted from each contrast-enhanced CT scan. The IBM score constructed by 11 CT-based IBMs, using LASSO-Cox regression method in training cohort. The multivariate analysis revealed that IBM score was the independent prognostic factor correlated with overall survival (OS) and progression-free survival (PFS). In the training cohort, the C-indices of IBM scores were 0.734 (95%CI, 0.664–0.804) and 0.678 (95%CI, 0.607–0.745) for OS and PFS, respectively. In the validation cohort, C-indices were 0.672 (95%CI, 0.578–0.766) and 0.662 (95%CI, 0.573–0.751) for OS and PFS, respectively. Kaplan-Meier survival analysis showed significantly different between risk subgroups in training and validation cohort. The decision curve showed the clinical usefulness of IBM score. Conclusions: The IBM score based on pre-treatment contrast-enhanced CT could predict the OS and PFS for patients with OSCC after definitive CCRT. Further multicentre studies with larger sample sizes are warranted.

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Long-term Clinical Outcome of Intensity-modulated Radiation Therapy for Locally Advanced Esophageal Squamous Cell Carcinoma

Abstract: IMRT was a practical and feasible technique to treat ESCC. Concurrent CRT could increase local tumor control and long-term survival. The CRT regimen was associated with a higher incidence of acute gastrointestinal and hematological toxicity.

Cited by 9 publications

References 25 publications

Initial experience of high-dose helical tomotherapy for medically inoperable esophageal cancer patients

Initial experience of high-dose helical tomotherapy for medically inoperable esophageal cancer patients

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

Imaging biomarkers of contrast-enhanced computed tomography predict survival in oesophageal cancer after definitive concurrent chemoradiotherapy

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