Radiation dose escalation can improve local disease control and survival among esophageal cancer patients with large primary tumor volume receiving definitive chemoradiotherapy

Abstract

Background This study aimed to investigate the correlation between primary tumor volume and cancer failure patterns in esophageal squamous cell carcinoma (ESCC) treated with definitive concurrent chemoradiotherapy (CCRT) and examine whether increasing radiation dose can improve the outcome. Methods We retrospectively reviewed 124 patients with stage III ESCC treated by definitive CCRT. The primary tumor volume calculated from the radiotherapy planning computed tomography scans was correlated to treatment response, time to disease progression, and overall survival. We further analyzed whether a higher radiation dose correlated with better disease control and patient survival. Results Patients with poor CCRT response had a larger primary tumor volume than those with good response (97.9 vs 64.3 cm 3 , P = 0.032). The optimal cutoff value to predict CCRT response was 55.3 cm 3 . Large primary tumor volume (≥ 55.3 cm 3 ) correlated with shorter time to tumor progression in the esophagus (13.6 vs 48.6 months, P = 0.033) compared with small tumor volume (< 55.3 cm 3 ). For the large esophageal tumors (≥ 55.3 cm 3 ), radiation dose > 60 gray significantly prolonged the time to tumor progression in esophagus (20.3 vs 10.1 months, P = 0.036) and overall survival (12.2 vs 8.0 months, P = 0.030), compared with dose ≤ 60 gray. In contrast, higher radiation dose did not benefit local disease control or overall survival in the small esophageal tumors (< 55.3 cm 3 ). Conclusion Large primary tumor volume correlates with poor local control and overall survival in ESCC treated with definitive CCRT. Radiation dose > 60 gray can improve the outcomes in patients with large primary tumor. Further prospective dose escalation trials are warranted.

A Prospective Phase II Study of Simultaneous Modulated Accelerated Radiotherapy Concurrently With CDDP/S1 for Esophageal Squamous Cell Carcinoma in the Elderly

“…They were also significantly associated with overall survival in univariate analysis. These results were in line with previous studies on esophageal cancer ( 32 , 33 ).…”

Esophageal fistula after definitive concurrent chemotherapy and intensity modulated radiotherapy for esophageal squamous cell carcinoma

“…All patients received definitive CCRT with IMRT technique as previously described [11][12][13]. Briefly, the clinical target volume (CTV) 1 included gross tumor volume (GTV) of the primary (GTVp) with a 5-cm craniocaudal and 1-cm radial margin along the esophagus, and GTV of lymph nodes (GTVn) with a 1-cm margin.…”

Multidisciplinary nutritional management improves nutritional and hospitalized outcomes of patients with esophageal cancer undergoing chemoradiotherapy: A randomized control trial

“…CRT has been a primary therapeutic regimen for patients with unresectable esophageal carcinoma, which is deemed medically unfit for surgery. [ 10 ] Previous studies indicated that patients treated with CRT may have significantly prolonged survival time, [ 29 , 30 ] but the adverse effects caused by CRT, that is, dysphagia, nausea, and vomiting, worsen the malnutrition [ 31 ] which in turn weakens the clinical effect of CRT and results in poor prognosis. Therefore, nutritional support during CRT plays an important role in improving the recovery of EC patients.…”