Randomized phase II trial comparing tumor bed alone with tumor bed and elective nodal postoperative radiotherapy in patients with locoregionally advanced thoracic esophageal squamous cell carcinoma

Xw, Cai; Zeng, Yue; Feng, Wen; Mn, Liu; Wang, Yu; Zhang, Q; Liu, Jing; Jm, Wang; Cx, Lv; Xl, Fu

doi:10.1093/dote/doz013

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…In addition to the limitation of a moderate study sample size as mentioned above, there were several other limitations in our study. First, the nonrandomized nature of our study made potential unmeasured confounder(s) (such as systemic therapy or radiotherapy details or micro‐metastases status) 27 , 28 , 29 always an issue although we used a PS method to adjust for observable covariates. Therefore, we reported the E‐value to assess the robustness of our results to potential unmeasured confounder(s).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness evaluation of adjuvant concurrent chemoradiotherapy for patients with positron emission tomography‐staged esophageal squamous cell carcinoma after complete resection: A population‐based cohort study

et al. 2022

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Background: The role of adjuvant concurrent chemoradiotherapy (ACCRT) is unclear for patients with esophageal squamous cell carcinoma (ESCC) who receive esophagectomy with clean margins. We compared the survival of the ACCRT versus observation groups for these patients staged with positron emission tomography (PET) via a population-based approach. Methods: Eligible patients with locally advanced ESCC diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratios (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between the ACCRT and observation groups. We also evaluated overall survival (OS) in subgroups of either with or without lymph node metastases. Results: Our primary analysis consisted of 105 patients in whom the covariates were well balanced after PS weighting. The HR for death when ACCRT was compared with observation was 0.58 (95% confidence interval 0.28-1.21, p = 0.15). The results were also not significantly different for IECM or in the subgroup analyses. Conclusion: We found that for patients with PET-staged ESCC who received esophagectomy with clean margins, the survival was not statistically different between ACCRT and observation. Further studies (randomized or larger sample size) are needed to clarify this issue.

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Section: Discussionmentioning

confidence: 99%

Effectiveness evaluation of adjuvant concurrent chemoradiotherapy for patients with positron emission tomography‐staged esophageal squamous cell carcinoma after complete resection: A population‐based cohort study

et al. 2022

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“…Patients in this study were screened from two treatment centers that included 429 ESCC patients with stage pT1-4N0-3M0. Patients in the S + R arm were screened from a prospective cohort that included 124 patients with stage pT3-T4 ESCC, who had received radiotherapy after surgery[14]. Patients in the S arm were screened from a retrospective cohort including 305 patients who had undergone radical surgery alone[12].…”

Section: Methodsmentioning

confidence: 99%

Difference in failure patterns of pT3-4N0-3M0 esophageal cancer treated by surgery vs surgery plus radiotherapy

Zeng

Wen

Liu

et al. 2019

WJGO

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BACKGROUNDThere has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy (PORT) after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma (ESCC).AIMTo investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.METHODSPatients with stage pT3-4N0-3M0 ESCC, who underwent surgery with or without PORT, were enrolled in this study. The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy. The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival (DFS) advantage after receiving adjuvant PORT. Statistical analyses were performed by the Kaplan-Meier method, Cox regression model, and Chi-squared test or Fisher’s exact test.RESULTSIn total, 230 patients with stage pT3-4N0-3M0 ESCC were included in this study. Fifty-six patients who received PORT were screened from a prospective cohort (S + R arm). And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014 (S arm). There were no significant differences in the clinical or pathological characteristics of patients between the two arms, except for tumor location (P = 0.031). The failure patterns between the two arms were significantly different (P < 0.001). Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S + R arm (92.0% vs 35.7%, P < 0.001 and 19.0% vs 75.0%, P < 0.001, respectively). The difference in the median DFS between the two arms was statistically significant (12.7 vs 8 mo, P = 0.048). Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases ≥ 3 (HR = 0.572, 95%CI: 0.430-0.762, P < 0.001) was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.CONCLUSIONPORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC. However, further studies need to be conducted to control hematogenous metastasis after PORT.

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“…It is essential to identify patients who may benefit from PORT. In the majority of previous studies on PORT, an adjuvant radiation dose (aRTD) of 50–60 Gy was used [ 14 , 15 , 22 , 23 , 24 , 25 , 26 , 27 ]. However, few studies have evaluated the impact of aRTD on survival outcomes and treatment-related toxicities in patients receiving PORT in the era of intensity-modulated radiotherapy (IMRT) [ 28 , 29 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Adjuvant Radiation Dose on Survival in Patients with Esophageal Squamous Cell Carcinoma

Han

Chang

Zhang

et al. 2022

Cancers

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Background: For patients with esophageal squamous cell carcinoma (ESCC) treated with surgery alone, the incidence of local-regional recurrence remains unfavorable. Postoperative radiotherapy (PORT) has been associated with increased local-regional recurrence-free survival (LRFS), although its application is limited by concerns of PORT-related toxicities. Methods: Among 3591 patients with ESCC analyzed in this study, 2765 patients with T3-4N0 and T1-4N1-3 lesions and specific local-regional status information were analyzed in a subsequent analysis of adjuvant radiation dose (aRTD) effect. Application of the restricted cubic spline regression model revealed a non-linear relationship between aRTD and survival/radiotoxicity. Linear regression analysis (LRA) was performed to evaluate correlations between LRFS and overall survival (OS)/ disease-free survival (DFS). Results: For patients staged T1–2N0, T1–2N1–3, T3–4N0, and T3–4N1–3, 5-year OS in PORT and non-PORT groups were 77.38% vs. 72.91%, p = 0.919, 52.35% vs. 46.60%, p = 0.032, 73.41% vs. 61.19%, p = 0.005 and 38.30% vs. 25.97%, p < 0.001. With aRTD escalation, hazard ratios (HRs) of OS/DFS declined until aRTD exceeded 50Gy, then increased, whereas that of LRFS declined until aRTD exceeded 50 Gy, then remained steady. HR of treatment-related mortality was stable until aRTD exceeded 50 Gy, then increased. LRA revealed strong correlations between LRFS and OS/DFS (r = 0.984 and r = 0.952, respectively). An absolute 1% advancement in LRFS resulted in 0.32% and 0.34% improvements in OS and DFS. Conclusions: An aRTD of 50Gy was well-tolerated, with favorable survival resulting from PORT-related LRFS improvement in patients staged T3–4N0 or T1-4N1–3. Further stratification analyses based on tumor burden would help determine potential PORT-beneficiaries.

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Randomized phase II trial comparing tumor bed alone with tumor bed and elective nodal postoperative radiotherapy in patients with locoregionally advanced thoracic esophageal squamous cell carcinoma

Cited by 4 publications

References 29 publications

Effectiveness evaluation of adjuvant concurrent chemoradiotherapy for patients with positron emission tomography‐staged esophageal squamous cell carcinoma after complete resection: A population‐based cohort study

Effectiveness evaluation of adjuvant concurrent chemoradiotherapy for patients with positron emission tomography‐staged esophageal squamous cell carcinoma after complete resection: A population‐based cohort study

Difference in failure patterns of pT3-4N0-3M0 esophageal cancer treated by surgery vs surgery plus radiotherapy

Effect of Adjuvant Radiation Dose on Survival in Patients with Esophageal Squamous Cell Carcinoma

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