Standard-dose versus high-dose radiotherapy with concurrent chemotherapy in esophageal cancer: A prospective randomized study

Abstract

Objective:The objective of this study is comparision of local and distant control rates with high-dose versus standard-dose radiotherapy along with concurrent chemotherapy in esophageal cancer – a prospective randomized study.Materials and Methods:Histologically proven Stage I–III patients with carcinoma esophagus were randomized into two groups. One group has been treated with standard-dose radiotherapy, i.e., a total dose of 50.4 Gy (1.8 Gy/day, 28#, 5 days/week). The other group (study arm) has received high-dose radiotherapy, i.e. a total dose of 64.8 Gy (1.8 Gy/day, 36#, 5 days/week). Both groups have received 2 cycles of 3 weekly concurrent chemotherapy (cisplatin 75 mg/m[2] on day 1 and 5-fluorouracil 750 mg/m[2] continuous intravenous infusion over 24 h on day 1–4). Follow-up response evaluation was done by both endoscopy and computed tomography scan after 6–8 weeks and after 2 months thereafter.Results:Out of a total of 28 patients, 68% showed a complete response, 14% showed partial response, and 18% patients developed progressive disease at first and subsequent follow up (median follow-up of 21 months). Among the complete response patients, rates were higher in high-dose group compared to standard-dose radiotherapy group (71% vs. 64%, P = 0.38). Treatment-related toxicities were acceptable in both groups.Conclusion:High-dose radiotherapy with concurrent chemotherapy seems to be more effective with acceptable toxicity in our study. However, further follow-up and large sample size may be required to validate the current study conclusion.

Investigation into the expression levels of MAGEA6 in esophageal squamous cell carcinoma and esophageal adenocarcinoma tissues

“…The causes of EC are highly complex, and there are limited options for its early diagnosis and treatment (3,4,22). EC is typically diagnosed in the middle and late stages of the disease (22,23), with conventional therapy using radiotherapy, chemotherapy and surgery (24,25). Progress has been made via the detection of a number of susceptibility genes and specific oncogenes (7,9), which provide an important starting point for research into target drug discovery.…”

Do Higher Radiation Doses with Concurrent Chemotherapy in the Definitive Treatment of Esophageal Cancer Improve Outcomes? A Meta-Analysis and Systematic Review

“…Given the above, radiation dose escalation has been proposed as a technique to obtain higher local-regional control (LRC) and survival rates, notably in Asian countries [14][15][16][17][18][19][20][21][22][23][24] . In recent years, multiple investigators have carried out studies comparing the curative impact of high-dose versus standard-dose radiation treatments, although conclusions have been inconsistent [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . Additionally, with advances in radiotherapy techniques, questions have been raised as to whether dose escalation utilizing computerized tomography (CT)-based radiotherapy approaches (including 3-Dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and proton therapy) could achieve improved outcomes with less toxicity compared to older approaches from the 2-D era.…”

“…There were 4946 EC patients included in the analyzed cohort, including 4775 ESCC patients, 142 EAC patients and 29 patients with other histology. [14] 2014 USA Retrospective 193/0 I-IV Standard dose 137 Median: 50.4 Gy (41.4-50.4 Gy) 3D-CRT, IMRT and Proton therapy High dose 56 Median: 60 Gy (52.2-66 Gy) Chen et al [15] 2016 China Retrospective* 648/0 I-IV Standard dose 324 50-50.4 Gy 3D-CRT and IMRT High dose 324 ≥60 Gy Chang et al [16] 2017 China Retrospective 2061/0 IA-IIIC Standard dose 1134 Median: 50.4 Gy (45-59.4 Gy) IMRT High dose 927 Median: 66.6 Gy (60-72 Gy) Kim et al [17] 2017 Korea Retrospective 230/6 II-III Standard dose 120 Median: 50.4 Gy (45-59.4 Gy) 3D-CRT and IMRT High dose 116 Median: 63 Gy (60-66.6 Gy) Nayan et al [18] 2018 India Prospective 28/0 II-III Standard dose 14 50.4 Gy 3D-CRT and IMRT High dose 14 64.8 Gy Ren et al [19] 2018 China Retrospective* 380/0 I-IV Standard dose 190 50.4-54 Gy 3D-CRT and IMRT High dose 190 60 Gy Ke et al [23] 2018 [25] 2016 USA [27] 2014 Japan Retrospective 42/0 I-IV Standard dose 30 50.4 Gy 3D-CRT and IMRT High dose 12 61.2 Gy Nemoto et al [28]…”

“…Five studies analyzed cCR rates of the two groups [17,18,23,27,28] . There was no difference between the two groups in this respect (OR 0.862, 95% CI 0.406-1.829; P=0.698, Figure 2).…”

“…Five studies analyzed the two-year OS of the two groups [16,18,19,23,26] . High-dose group had a significant advantage over the standard-dose group (HR 0.744, 95% CI 0.657-0.843; P<0.001, Figure 5).…”