Positive impact of radiation dose on disease free survival and locoregional control in postoperative radiotherapy for squamous cell carcinoma of esophagus

Abstract

The effect of total radiation dose (TRD) on the outcome of patients with postoperative radiotherapy (RT) for squamous cell carcinoma of esophagus was assessed. Sixty-seven patients with esophagectomy, followed by postoperative RT for squamous cell carcinoma of esophagus from June 1984 through February 2001, were retrospectively reviewed. Of these, 13 patients were excluded. No patient had chemotherapy. Patients were classified into two groups based on TRD delivered: TRD of less than 50 Gy (Group A, n = 16) and at least 50 Gy (Group B, n = 38). Follow-up duration of all patients ranged from 4 to 140 months (median, 14). Median TRD of Group A and B were 45 Gy (range, 45-48.6) and 54 Gy (range, 50-59.6), respectively. Median overall survival (OS) and disease-free survival (DFS) of all patients were 15 and 10 months, respectively. Although the TRD of 50 Gy or higher was marginally significant for improved OS (hazard ration [HR] 0.559, P = 0.066), it was statistically significant for improved DFS (HR 0.398, P = 0.011), and locoregional recurrence-free survival (HR 0.165, P = 0.001) with multivariate analysis. Three patients in group A and two in group B experienced a complication of grade 3 or higher. Our study suggests a positive impact of TRD of 50 Gy or higher on DFS and locoregional control, with acceptable morbidity in postoperative RT for patients with squamous cell carcinoma of esophagus. According to the present analysis, TRD should be at least 50 Gy in postoperative RT alone setting.

A retrospective study of pattern of recurrence after radical surgery for thoracic esophageal carcinoma with or without postoperative radiotherapy

“…For infield recurrences, we might think about whether 50 Gy of biological effective dose (BED) was enough for sub-clinic or micrometastasis tumor. Moon et al (39) suggested that total radiation dose should be at least 50 Gy in PRT alone. Also, researches (3,22,38,40) showed that the anastomotic recurrence ratio was low (4.0% in my study), we should not include it into CTV.…”

Role of Postoperative Radiotherapy for Microscopic Margin Involvement in the Squamous Cell Carcinoma of Esophagus

“…Third, most patients (90%) received radiotherapy alone and not concurrent CRT. Fourth, 34% of the patients received a radiation dose lower than 50 Gy, which is considered insufficient [22]. Finally, although it was not statistically significant, there was a trend toward improved survival for patients treated in the later period of accrual.…”

<p>Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy</p>

“…Due to the complex lymphatic drainage system, 45 it is always challenging to design an appropriate target volume for preoperative, postoperative, or definitive radiotherapy in EC. Many target volumes have been used in past decades for PORT of EC, including: (1) a 3 to 5 cm margin at both the cephalad and caudal ends and a 1 to 2 cm margin around the initial tumor; 5,46 (2) the supraclavicular areas and whole mediastinum with or without celiac areas (left gastric or/and paracardiac lymph nodes); 4,15,17,47 (3): the supraclavicular areas and part of the mediastinum (from the cricothyroid membrane to 3 cm below the carina for proximal diseases and from the T1 vertebra to 3 cm below the primary tumor bed for middle and lower diseases); 19,48 (4) a T-shaped field that includes only the bilateral supraclavicular area, upper and middle mediastinum, and primary tumor bed (from the upper edge of the sixth cervical vertebra to 3 cm below the carina for proximal diseases to the lower edge of the primary gross tumor for middle and lower diseases); 24 (5): the bilateral supraclavicular areas and upper mediastinum; 18,49 and (6) others. 3,7,39 The irradiation fields of PORT used in the RCTs are shown in Table 4.…”

“…A retrospective study analyzed the effect of TRD on the outcome in patients with PORT for ESCC. 46 In this study, 54 patients were classified into two groups based on TRD delivery: the low group (less than 50 Gy) and the high group (at least 50 Gy). Although the high group was marginally significant for improved OS (hazard ratio (HR)=0.559, P=0.066), it was statistically significant for improved DFS (HR=0.398, P=0.011), and locoregional recurrence-free survival (HR=0.165, P=0.001) with acceptable complications.…”