Three-Dimensional Conformal Radiation Therapy for Esophageal Squamous Cell Carcinoma: Is Elective Nodal Irradiation Necessary?

Zhao, Kuaile; Ma, Jizhen; Guang, Liu; Wu, Keyi; Shi, Xiaoling; Jia, Guanghong

doi:10.1016/j.ijrobp.2009.02.078

Cited by 86 publications

(78 citation statements)

References 17 publications

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“…In an analysis of recurrence patterns after definitive ccrt not using eni, Button et al 20 reported that 3 patients (2%) developed isolated regional recurrence. In a study of ifi in patients with locally advanced eca, the rate of in-field recurrence was 44% (compared with the 64.3% reported here), but 8% of patients experienced isolated regional nodal recurrence (compared with 1.8% in the present study) 8 . Thus, regardless of whether radiation was administered using eni or ifi, regional lymph node failure was not the main pattern of recurrence in advanced-stage eca patients.…”

Section: Discussioncontrasting

confidence: 74%

“…In our study, no grade 4 acute toxicities were observed, and grade 3 leucocytopenia, anemia, thrombocytopenia, and esophagitis occurred in 25%, 8.9%, 5.4%, and 0% of patients respectively. Zhao et al 8 reported rates of grade 3 acute and late toxicities of 9% and 6% respectively after ifi, and no patients experienced acute or late grade 4 or 5 toxicities. Ma et al 21 reported significant differences between ifi and eni groups with respect to hematologic toxicity, infection, and vomiting.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, Kawaguchi et al 7 found that ifi did not result in a significant incidence of regional lymph node failure in patients with clinical stage i thoracic eca. In some studies, 3-dimensional conformal radiotherapy without eni was used in locally advanced patients, for whom the rate of isolated out-of-field nodal failure was only 2%-8% 8,9 .…”

Section: Introductionmentioning

confidence: 99%

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Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Zhao

Zhang

et al. 2016

Current Oncology

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Objectives Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus.Methods Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time.Results In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively. ConclusionsFor patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Zhao

Zhang

et al. 2016

Current Oncology

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“…Dirix et al [16][17] confirmed that IMRT and 3D-CRT improved the survival of patients with head-and-neck cancer due to improved dosimetry. Other studies reported better OS from IMRT and 3D-CRT than conventional 2D radiotherapy for treatment of esophageal cancer, regardless of survival rate and normal tissue sparing [18][19][20][21]. In particular, Kong et al…”

Section: Discussionmentioning

confidence: 99%

Results and prognostic factors of 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for esophageal carcinoma

Tan¹,

Xiao²,

Zhang³

et al. 2015

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The aim of this study was to summarize the outcomes and prognostic factors of 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for esophageal carcinoma in our institute. Five hundred ninety-two patients received radiotherapy for esophageal carcinoma (123 with 3D-CRT, 469 with IMRT) from January 2002 to March 2012. Three hundred sixty patients received radiotherapy alone and 232 patients received radiotherapy and chemotherapy. The endpoints were overall survival (OS), progression-free survival (PFS). Kaplan-Meier analysis was used to calculate endpoints, the log-rank test for univariate analysis, and multivariate analysis to identify independent prognostic factors. The median follow-up time was 22.6 months and the median dose was 60 Gy. The 1-year OS, PFS were 65.3%, 52.1%; the 3-year OS, PFS were 34.0%, 28.0%; and the 5-year OS, PFS were 23.5%, 19.6%. The median OS was 20 months (95% CI: 17.9-22.1 months) and the median PFS was 14 months (95% CI: 11.8-16.2 months). Univariate analysis indicated that sex, N-stage, M-stage, TNM stage, radiotherapy dose, weight loss before treatment, smoking, and drinking affected OS and PFS (p < 0.05 for all). T-stage affected OS (p = 0.042), but no significant influence on PFS (p = 0.101). The independent prognostic factors for better OS and PFS were early clinical TNM stage, high radiotherapy dose, and female sex (p < 0.05 for all). The results of esophageal carcinoma patients treated with 3D-CRT and IMRT with or without chemotherapy were promising. Clinical TNM stage, radiotherapy dose and sex were the independent prognostic factors for OS and PFS.

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“…It was previously reported that, compared with involved-field irradiation (IFI), ENI does not improve the local control rate or long-term survival of patients with esophageal cancer (4). Previous studies have indicated that ENI may prevent regional lymph node metastasis (5,6), whereas other studies (7)(8)(9) reported that the isolate out-of-field nodal failure rate was low and overall survival did not decrease when IFI was used (6,7). Ji et al (10) reported the results of a prospective study on 3D-CRT in 39 patients with esophageal cancer without distant metastases, and revealed that lymph node stations in close proximity to esophageal malignant tumors receive considerable incidental radiation doses with IFI, which may contribute to the elimination of subclinical lesions.…”

Section: Introductionmentioning

confidence: 99%

Radiation dose to the lymph drainage area in esophageal cancer with involved-field irradiation

et al. 2015

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Abstract. The aim of this study was to quantify the radiation dose to the corresponding lymph drainage area in esophageal cancer using three-dimensional conformal radiation therapy (3D-CRT) with involved-field irradiation (IFI) and to analyze associated factors. A retrospective analysis of 81 patients with esophageal cancer was conducted. According to the location of the lesions, the lymph drainage area was delineated and the dosimetric parameters were calculated. The 1-, 3-, 5-and 8-year survival rates of the patients were 67.90, 33.33, 20.99 and 11.11%, respectively. Based on the dose-volume histogram in the treatment plan, we calculated the volume percentage of the planning target volume including clinically positive lymph nodes (PTV-N) receiving radiation doses of 30, 35, 40, ). The median values of V PTV-N30-50 were 73, 70, 67, 64 and 58%, respectively. The prescribed dose size exhibited no correlation with V PTV-N30-35 , but did exhibit a significant correlation with V PTV-N40-50 ; the radiation field was not correlated with V PTV-N30-45 , but exhibited a significant correlation with V PTV-N50 ; the length of the lesion on esophageal barium meal X-ray and the PTV were significantly correlated with V PTV-N30-50 . The analysis of variance revealed that the V PTV-NX value in the upper thoracic segment was higher compared with that in the middle and lower thoracic segments; V PTV-N30-35 values differed significantly according to the different locations of the lesions, whereas V PTV-N40-50 values exhibited no significant differences. The value of V PTV-NX exerted no significant effect on long-term patient survival. Therefore, the corresponding lymph drainage area of esophageal cancer is subjected to a certain radiation dose when patients undergo 3D-CRT with IFI, which may play a role in the prevention of regional nodal metastasis. However, this hypothesis requires confirmation by further clinical studies. IntroductionThere is significant controversy regarding target region delineation by esophageal cancer radiotherapy in different regions. In the RTOG85-01 randomized trial (1), irradiation of the entire esophagus for esophageal cancer was recommended. In the RTOG94-05 trial (2), an area with a margin of 2-5 cm surrounding the gross tumor volume (GTV) was defined as the clinical target volume (CTV). The supraclavicular nodes were included only when the tumor was located in the cervical esophageal area. However, the results of these two trials were not satisfactory, as the survival and local control rates did not improve significantly. In the RTOG01-33 trial (3), three-dimensional conformal radiation therapy (3D-CRT) technology was applied. The CTV included a 3-cm margin around the GTV, while the planning target volume (PTV) included a margin of ≤2 cm around the CTV. Over the last few years, an increasing number of studies have been conducted on elective nodal irradiation (ENI) for esophageal cancer; however, their conclusions have been inconsistent. It was previously reported that, compared with involved-field ...

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Three-Dimensional Conformal Radiation Therapy for Esophageal Squamous Cell Carcinoma: Is Elective Nodal Irradiation Necessary?

Cited by 86 publications

References 17 publications

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Involved-Field Irradiation in Definitive Chemoradiotherapy for T4 Squamous Cell Carcinoma of the Esophagus

Results and prognostic factors of 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for esophageal carcinoma

Radiation dose to the lymph drainage area in esophageal cancer with involved-field irradiation

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