With or without Consolidation Chemotherapy for Clinical Responder to Definitive Concurrent Chemoradiation in Stage II-III Esophageal Squamous Cell Carcinoma

Abstract

Stereotactic body radiation therapy (SBRT) has become a treatment option for patients with unresectable focal hepatocellular carcinoma (HCC). Correlation between dose-volumetric parameters and late effects on liver function remain unclear. The purpose of this study is to analyze the factors predictive of liver dysfunction as a late effect after dynamic tumor-tracking (DTT) SBRT for HCC. Materials/Methods: Eligibility criteria in this study were as follows: (1) treated with DTT-SBRT for HCC; (2) received no additional treatment within 6 months after SBRT; (3) sustained virologic response (SVR) had been achieved; and (4) no severe comorbidities. Eleven patients treated at our institution between 2013 and 2015 were enrolled in this study. Following dose-volumetric parameters were calculated; percentage of the liver volume receiving a dose excess of arbitrary doses (e.g. V5 [%] for 5 Gy) and the absolute and the percentage of the liver volume spared from receiving a dose greater than the arbitrary doses (e.g. VS5 [cc] and VS5 [%]) for 5 Gy, 10 Gy, 20 Gy and 30 Gy, respectively. The mainly irradiated lobe of liver (MIL) was defined as the lobe of liver with much more V20 than the other lobe of liver. Dose-volumetric parameters were analyzed for the right, the left and the MIL as well as a whole liver. Laboratory and imaging data of 7 to 12 months after completion of SBRT were analyzed in each patient. Change in liver function was assessed using linear predictor of Albumin-Bilirubin (ALBI) scoring model defined by serous albumin and bilirubin values. Volumetric changes of the liver were also assessed between pre-SBRT and post-SBRT. Spearman correlation was used to evaluate the relationship between continuous variables. Results: Median age was 79 years (range, 66e88). The etiology was HCV (73%), HBV (18%) and other (18%). Median delivered SBRT dose was 48 Gy (range, 40e56 Gy). Nine patients received other local treatment before SBRT. Median linear predictor of ALBI model before SBRT was À2.35 (range, À2.94 to À2.19) and median change in linear predictor was 0.018 (range, À0.72 to 0.56). There was strong correlation between change in linear predictor of ALBI and V5, VS5 [cc] and VS5 [%] of MIL (The Spearman correlation coefficients for V5, VS5 [cc] and VS5 [%] were 0.818, À0.809 and À0.818, respectively). Pre-treatment ALBI score was not a significant predictive factor for late liver dysfunction. Decrease in liver volume did not have a significant correlation with late liver dysfunction. Conclusion: The liver volume irradiated by low dose (V5) and the spared liver volume (VS5) of mainly irradiated lobe of liver were associated with late deterioration of liver function based on ALBI model after DTT-SBRT for HCC.

Long-Term Survival in Nonsurgical Esophageal Cancer Patients Who Received Consolidation Chemotherapy Compared With Patients Who Received Concurrent Chemoradiotherapy Alone: A Systematic Review and Meta-Analysis

“…We further analyzed the data eligible in our articles and found that the clinical features of 7 of those articles are similar in the CCT and the CCRT-alone groups. The clinical features in 4 articles were not detailed ( 9 , 18 , 23 , 24 ). The numbers of patients who did not accept CCT after CCRT reported by Koh, H. K. et al ( 18 ).…”

“…In our meta-analysis, 1111 patients in 6 included articles demonstrated that CCT followed by CCRT can prolong PFS of EC patients (HR 0.61; 95% CI 0.44–0.84; p=0.003). Except for trials conducted by Chen, Y. et al ( 24 ). and Wu, S. X. et al.…”

“…After full text screening, 57 studies were excluded for reasons such as lack of relevant data or data duplication. Finally, 11 case-control studies were included in this metaanalysis (8)(9)(10)(11)(18)(19)(20)(21)(22)(23)(24).…”