Reduced toxicity with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy compared with conventional two-dimensional radiotherapy for esophageal squamous cell carcinoma: a secondary analysis of data from four prospective clinical

Deng, Jiaying; Wang, C.; Shi, Xiaoling; Jia, Guanghong; Wang, Y.; Liu, Y.; Zhao, Kuaile

doi:10.1111/dote.12435

Cited by 24 publications

(17 citation statements)

References 24 publications

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“…The five‐year OS in definition radiotherapy for esophageal carcinoma was 42% and 13% with or without diagnostic computed tomography scanning, respectively . Furthermore, a lower toxicity was also observed using 3‐DCRT compared with conventional two‐dimensional radiotherapy …”

Section: Introductionmentioning

confidence: 92%

“…11 Furthermore, a lower toxicity was also observed using 3-DCRT compared with conventional two-dimensional radiotherapy. 12 Previously, we conducted a prospective phase II study to explore the efficacy of late-course sequential boost 3-DCRT alone for esophageal SCC, and the two-year OS of 69% was attained. 13 To our knowledge, there were limited longterm survival data on esophageal SCC using 3-DCRT or intensity-modulated radiotherapy (IMRT) alone.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 92%

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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“…It had been reported that there was no significant difference in overall survival, failure-free survival, as well as regional failure-free survival, among the IMRT patients (n � 64) and 2D-RT patients (n � 37) for the treatment of cervical esophageal squamous cell carcinoma from 2001 to 2012 [15]. No substantial survival advantages were detected from the use of 3D-CRT/IMRT in a retrospective analysis based on four prospective clinical trials, which assessed the toxicity as well as long-term survival of ESCC patients treated with 3D-CRT or IMRT in comparison with that of 2D-RT [22]. e ambiguous or contradictory results may be due to the lack of data concerning the potential value of IMRT in a dose-escalated radiotherapy setting.…”

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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“…Thus, the optimal radiation dose remains to be determined. Finally, three-dimensional conformal radiotherapy (3DCRT) for unresectable EC yields 5-year OS rates of 34-45.6% [10][11][12][13], which is an improvement over the rates reported in the RTOG 85 − 01 and 94 − 05 studies. Moreover, radiotherapy (median dose, 60 Gy) with or without concurrent chemotherapy yields 5-year OS rates of 34.7% and 27.7%, respectively [14].…”

Section: Introductionmentioning

confidence: 88%

A multicenter prospective phase III clinical randomized study of simultaneous integrated boost intensity-modulated radiotherapy with or without concurrent chemotherapy in patients with esophageal cancer: 3JECROG P-02 study protocol

Gao

Wang

Han

et al. 2020

Preprint

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Background: Since the development of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy (IMRT), no prospective study has investigated whether concurrent chemoradiotherapy (SIB-IMRT with 60 Gy) remains superior to radiotherapy (SIB-IMRT) alone for unresectable esophageal cancer (EC). Furthermore, the optimal therapeutic regimen for patients who cannot tolerate concurrent chemoradiotherapy is unclear. We recently completed a phase I/II radiation dose-escalation trial using simultaneous integrated boost (SIB), elective nodal irradiation, and concurrent chemotherapy for unresectable EC. We now intend to conduct a prospective, phase III, randomized study of SIB-IMRT with or without concurrent chemotherapy. We aim to find a safe, practical, and effective therapeutic regimen to replace the conventional segmentation (1.8–2.0 Gy) treatment mode (radiotherapy ± chemotherapy) for unresectable EC.Methods: This two-arm, open, randomized, multicenter, phase III trial will recruit esophageal squamous cell carcinoma patients (stage IIA–IVB [UICC 2002]; IVB only with metastasis to the supraclavicular or celiac lymph nodes). In all, 164 patients will be randomized using a 1:1 allocation ratio, and stratified by study site and disease stage, especially the extent of lymph node metastasis. Patients in the SIB arm will receive definitive SIB radiotherapy (95% planning target volume/planning gross tumor volume, 50.4 Gy/59.92 Gy/28 f, equivalent dose in 2-Gy fractions = 60.62 Gy). Patients in the SIB + concurrent chemotherapy arm will receive definitive SIB radiotherapy with weekly paclitaxel and a platinum-based drug (5–6 weeks). Four cycles of consolidated chemoradiotherapy will also be recommended. The primary objective is to compare the 1-year, 2-year, and 3-year overall survival of the SIB + chemotherapy group and SIB groups. Secondary objectives include progression-free survival, local recurrence-free rate, completion rate, and adverse events. Detailed radiotherapy protocol and quality-assurance procedures have been incorporated into this trial.Discussion: In unresectable, locally advanced EC, a safe and effective total radiotherapy dose and reasonable segmentation doses are required for the clinical application of SIB-IMRT + two-drug chemotherapy. Whether this protocol will replace the standard treatment regimen will be prospectively investigated. The effects of SIB-IMRT in patients with poor physical condition who cannot tolerate definitive chemoradiotherapy will also be investigated.Trial registration: clinicaltrials.gov (NCT03308552, November 1, 2017).

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Reduced toxicity with three-dimensional conformal radiotherapy or intensity-modulated radiotherapy compared with conventional two-dimensional radiotherapy for esophageal squamous cell carcinoma: a secondary analysis of data from four prospective clinical

Cited by 24 publications

References 24 publications

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

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

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

A multicenter prospective phase III clinical randomized study of simultaneous integrated boost intensity-modulated radiotherapy with or without concurrent chemotherapy in patients with esophageal cancer: 3JECROG P-02 study protocol

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