Radiotherapy for esophageal carcinoma: dose, response and survival

Luo, Yao; Mao, Qingfeng; Wang, Xiaoli; Yu, Jinming; Li, Minghuan

doi:10.2147/cmar.s144687

Cited by 24 publications

(24 citation statements)

References 76 publications

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“…RT plays an important role in improving the survival of EC patients who are not eligible for surgery [9]. The standard dose recommended by European and North American guidelines is 50.4 Gy as total dose [20], in 28 fractions of 1.8 Gy/day. Regarding Asian countries, the standard dose recommended is a total treatment of 60 Gy [20].…”

Section: Biological Basis Of Cancer Radiation Therapymentioning

confidence: 99%

The Critical Role of Hypoxic Microenvironment and Epigenetic Deregulation in Esophageal Cancer Radioresistance

Macedo-Silva

Miranda-Gonçalves

Henrique

et al. 2019

Genes

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Esophageal cancer (EC) is the seventh most common cancer worldwide and the sixth leading cause of death, according to Globocan 2018. Despite efforts made for therapeutic advances, EC remains highly lethal, portending a five-year overall survival of just 15–20%. Hence, the discovery of new molecular targets that might improve therapeutic efficacy is urgently needed. Due to high proliferative rates and also the limited oxygen and nutrient diffusion in tumors, the development of hypoxic regions and consequent activation of hypoxia-inducible factors (HIFs) are a common characteristic of solid tumors, including EC. Accordingly, HIF-1α, involved in cell cycle deregulation, apoptosis, angiogenesis induction and proliferation in cancer, constitutes a predictive marker of resistance to radiotherapy (RT). Deregulation of epigenetic mechanisms, including aberrant DNA methylation and histone modifications, have emerged as critical factors in cancer development and progression. Recently, interactions between epigenetic enzymes and HIF-1α transcription factors have been reported. Thus, further insight into hypoxia-induced epigenetic alterations in EC may allow the identification of novel therapeutic targets and predictive biomarkers, impacting on patient survival and quality of life.

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Section: Biological Basis Of Cancer Radiation Therapymentioning

confidence: 99%

The Critical Role of Hypoxic Microenvironment and Epigenetic Deregulation in Esophageal Cancer Radioresistance

Macedo-Silva

Miranda-Gonçalves

Henrique

et al. 2019

Genes

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“…The estimated numbers of incident and mortality cases of esophageal cancer are 477 000 and 375 000 annually in China, respectively . The main histological subtype of esophageal cancer is squamous cell carcinoma (SCC) in East Asia . The prognosis of esophageal SCC is poor; the five‐year survival rate remains <20% …”

Section: Introductionmentioning

confidence: 99%

“…2 The main histological subtype of esophageal cancer is squamous cell carcinoma (SCC) in East Asia. 3 The prognosis of esophageal SCC is poor; the five-year survival rate remains <20%. 4 Concurrent chemoradiotherapy was a standard treatment for patients with locally advanced esophageal cancer; the five-year overall survival (OS) was 14-26%.…”

Section: Introductionmentioning

confidence: 99%

Three‐dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10‐year survival outcomes

Fan

Wu²,

Wang

et al. 2019

Thoracic Cancer

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Background Concurrent chemoradiation is the standard treatment for locally advanced esophageal squamous cell carcinoma (SCC). We conducted a phase II study to explore the effect of three‐dimensional conformal radiotherapy (3‐DCRT) alone for patients with locally advanced esophageal SCC. This study aimed to analyze the long‐term survival outcomes. Methods Between November 2004 and April 2007, 30 patients with thoracic esophageal SCC underwent late‐course sequential boost 3‐DCRT at Fudan University Shanghai Cancer Center. The planning target volume (PTV1) comprised a 1.2–1.5 cm lateral margin around the gross tumor volume and a 3.0 cm margin, superior and inferior to the gross tumor volume. PTV2 encompassed the gross tumor volume with a margin of 0.5–0.7 cm. The PTV1 dose delivered was 50 Gy, and the PTV2 dose was a boost dose of 16 Gy, resulting in a total dose of 66 Gy. No chemotherapy was administered. Results The median follow‐up time was 30 months for all patients, and 132 months for patients who were alive. The median overall survival was 27 months (95% confidence interval [CI] 18.9–35.0). The 2‐, 5‐, and 10‐year overall survival rates were 56.6%, 33.3%, and 26.6%, respectively. The median progression‐free survival was 14 months (95% CI 7.7–20.2 months), and the 2‐, 5‐, and 10‐year progression‐free survival rates were 33.3%, 30.0%, and 26.6%, respectively. No severe late toxicity was observed in long‐term survivors. Conclusion Late‐course sequential boost 3‐DCRT is safe and feasible with promising long‐term outcomes for esophageal SCC.

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“…In the USA doses of 50-50.4 Gy are advised although many authors believe that, in order to increase the chance of better local control and survival, higher doses to the primary tumor should be used, which indeed is the case in Europe and some other parts of the world. 1,2,5,7,15…”

Section: Discussionmentioning

confidence: 99%

Definitive radiochemotherapy in esophageal cancer - a single institution experience

Anderluh

Toplak

Velenik

et al. 2019

Radiology and Oncology

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BackgroundDefinitive radiochemotherapy is the preferred treatment option in patients with the cancer of the cervical esophagus and a viable treatment option in patients with the cancer of lower two thirds of the esophagus, who decline proposed surgical treatment. The purpose of the study was to evaluate the treatment results with definitive radiochemotherapy of patients with esophageal cancer, treated in a single institution in the period from 2010 to 2017.Patients and methodsAll available medical data for 55 patients with esophageal cancer, who were treated with definitive radiochemotherapy with curative intent, were analyzed retrospectively. Patients were irradiated to a total dose to the tumor of 70 Gy (2 Gy per fraction) in upper third (cervical) tumors or to the mean total dose of 57.6 Gy (1.8 Gy per fraction) in middle third (intrathoracic) tumors. All but one patient received concomitant chemotherapy, with the majority of them (41 patients; 74.5%) receiving concomitant chemotherapy with 5-fluorouracil in continuous 96 hours infusion and cisplatin. The main endpoints of the study were overall survival (OS; death of any cause), locoregional control (LRC; local and/or regional disease recurrence) and disease-free survival (DFS; recurrence of any kind and/or new primary malignoma). Univariate analysis testing the impact of different parameters on survivals and analysis of treatment related side effects were performed as well.ResultsThe mean age of patients was 62 years (SD 9 years; range: 29–80 years). Majority of them had squamous cell cancer (53 patients; 96.4%) in the stage T3 or T4 (47 patients; 85.5%) and/or N+ disease (35 patients; 63.6%). Median follow-up time for the whole group of patients was 16.8 months (range: 0.3–81.8 months). At the time of analysis 14 (25.5%) patients were still alive. Rates for OS, LRC and DFS at two and five years were as follows: 47% and 19.4%; 43.7% and 41%; 32.1% and 11.5%, respectively.ConclusionsThe study results of treatment with definitive radiochemotherapy in patients with esophageal cancer are similar to the results of other studies. Majority of patients ended the treatment according to the protocol, which at least in part can be attributed to the adequate and well organized supportive treatment in our institution.

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Radiotherapy for esophageal carcinoma: dose, response and survival

Cited by 24 publications

References 76 publications

The Critical Role of Hypoxic Microenvironment and Epigenetic Deregulation in Esophageal Cancer Radioresistance

The Critical Role of Hypoxic Microenvironment and Epigenetic Deregulation in Esophageal Cancer Radioresistance

Three‐dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10‐year survival outcomes

Definitive radiochemotherapy in esophageal cancer - a single institution experience

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