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Zhang J, Li M, Zhang K, Zheng A, Li G, Huang W, Chen S, Chen X, Li X, Sheng Y, Sun X, Liu L, Liu X, Li J, Wang J, Ge H, Ye S, Pang Q, Zhang X, Dai S, Yu R, Gu W, Dai M, Siqin G, Han Y, Ge X, Yuan X, Yang Y, Zhu H, Pu J, Dong L, Sun X, Zhou J, Mao W, Gao F, Lin H, Gong H, Zhou T, Li Z, Li H, Wang Z, Li B. Concurrent chemoradiotherapyof different radiation doses and different irradiation fields for locally advanced thoracic esophageal squamous cell carcinoma: A randomized, multicenter, phase III clinical trial. Cancer Commun (Lond) 2024; 44:1173-1188. [PMID: 39161079 PMCID: PMC11483711 DOI: 10.1002/cac2.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 07/10/2024] [Accepted: 07/24/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). However, the optimal radiotherapy regimen, particularly in terms of total dose and planned range of irradiation field, remains unclear. This phase III clinical trial aimed to compare the survival benefits between different radiation doses and different target fields. METHODS This trial compared two aspects of radiation treatment, total dose and field, using a two-by-two factorial design. The high-dose (HD) group received 59.4 Gy radiation, and the standard-dose (SD) group received 50.4 Gy. The involved field irradiation (IFI) group and elective nodal irradiation (ENI) group adopted different irradiation ranges. The participants were assigned to one of the four groups (HD+ENI, HD+IFI, SD+ENI and SD+IFI). The primary endpoint was overall survival (OS), and the secondary endpoints included progression-free survival (PFS). The synergy indexwas used to measure the interaction effect between dose and field. RESULTS The interaction analysis did not reveal significant synergistic effects between the dose and irradiation field. In comparison to the target field, patients in IFI or ENI showed similar OS (hazard ratio [HR] = 0.99, 95% CI: 0.80-1.23, p = 0.930) and PFS (HR = 1.02, 95% CI: 0.82-1.25). The HD treatment did not show significantly prolonged OS compared with SD (HR = 0.90, 95% CI: 0.72-1.11, p = 0.318), but it suggested improved PFS (25.2 months to 18.0 months). Among the four groups, the HD+IFI group presented the best survival, while the SD+IFI group had the worst prognosis. No significant difference in the occurrence of severe adverse events was found in dose or field comparisons. CONCLUSIONS IFI demonstrated similar treatment efficacy to ENI in CCRT of ESCC. The HD demonstrated improved PFS, but did not significantly improve OS. The dose escalation based on IFI (HD+IFI) showed better therapeutic efficacy than the current recommendation (SD+ENI) and is worth further validation.
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Fan C, Wang X, Zheng X, Sun Y, Ye K, Jiang Y, Liu X, Xu W, Liu Y, Yang Y, Liu J, Jiang Q, He C, Wu X, Nie X, Zhang J, Tan B, Wang W, Zhang Y, Feng Z, Yang C, Lu Y, Liu H, Chen X, Xu J, Liu F, Zheng X, Wang J, Wu S, Chen G, Zhang Y, Jin L, Ge H. Consolidation chemotherapy after definitive concurrent chemoradiotherapy in patients with inoperable esophageal squamous cell carcinoma: a multicenter non-inferiority phase III randomized clinical trial. BMC Cancer 2024; 24:321. [PMID: 38454345 PMCID: PMC10921589 DOI: 10.1186/s12885-024-12002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/13/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Definitive concurrent chemoradiotherapy (dCCRT) is the gold standard for the treatment of locally advanced esophageal squamous cell carcinoma (ESCC). However, the potential benefits of consolidation chemotherapy after dCCRT in patients with esophageal cancer remain debatable. Prospective randomized controlled trials comparing the outcomes of dCCRT with or without consolidation chemotherapy in patients with ESCC are lacking. In this study, we aim to generate evidence regarding consolidation chemotherapy efficacy in patients with locally advanced, inoperable ESCC. METHODS This is a multicenter, prospective, open-label, phase-III randomized controlled trial comparing non-inferiority of dCCRT alone to consolidation chemotherapy following dCCRT. In total, 600 patients will be enrolled and randomly assigned in a 1:1 ratio to receive either consolidation chemotherapy after dCCRT (Arm A) or dCCRT alone (Arm B). Overall survival will be the primary endpoint, whereas progression-free survival, locoregional progression-free survival, distant metastasis-free survival, and treatment-related toxicity will be the secondary endpoints. DISCUSSION This study aid in further understanding the effects of consolidation chemotherapy after dCCRT in patients with locally advanced, inoperable ESCC. TRIAL REGISTRATION ChiCTR1800017646.
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Affiliation(s)
- Chengcheng Fan
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xu Wang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xiaoli Zheng
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yanan Sun
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Ke Ye
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yue Jiang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xiao Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wencai Xu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yang Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yuanyuan Yang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jinsong Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Qiong Jiang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Chunyu He
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xiaoyuan Wu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xin Nie
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jingwei Zhang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Bo Tan
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Wen Wang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yougai Zhang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Zhuo Feng
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Chengliang Yang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yufei Lu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Hailong Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xijuan Chen
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jing Xu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Fang Liu
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Xuefeng Zheng
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jianhua Wang
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Shang Wu
- Xinyang Hospital Affiliated to Zhengzhou University & Xinyang Central Hospital, Xinyang, 464000, China
| | - Guofu Chen
- Xinyang Hospital Affiliated to Zhengzhou University & Xinyang Central Hospital, Xinyang, 464000, China
| | | | - Linzhi Jin
- Anyang Cancer Hospital, Anyang, 455000, China
| | - Hong Ge
- The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
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Li C, Pan Y, Yang X, Jing D, Chen Y, Luo C, Qiu J, Hu Y, Zhang Z, Shi L, Shen L, Zhou R, Lu S, Xiao X, Chen T. CT-based radiomics for predicting radio-chemotherapy response and overall survival in nonsurgical esophageal carcinoma. Front Oncol 2023; 13:1219106. [PMID: 37681029 PMCID: PMC10482418 DOI: 10.3389/fonc.2023.1219106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Background To predict treatment response and 2 years overall survival (OS) of radio-chemotherapy in patients with esophageal cancer (EC) by radiomics based on the computed tomography (CT) images. Methods This study retrospectively collected 171 nonsurgical EC patients treated with radio-chemotherapy from Jan 2010 to Jan 2019. 80 patients were randomly divided into training (n=64) and validation (n=16) cohorts to predict the radiochemotherapy response. The models predicting treatment response were established by Lasso and logistic regression. A total of 156 patients were allocated into the training cohort (n=110), validation cohort (n=23) and test set (n=23) to predict 2-year OS. The Lasso Cox model and Cox proportional hazards model established the models predicting 2-year OS. Results To predict the radiochemotherapy response, WFK as a radiomics feature, and clinical stages and clinical M stages (cM) as clinical features were selected to construct the clinical-radiomics model, achieving 0.78 and 0.75 AUC (area under the curve) in the training and validation sets, respectively. Furthermore, radiomics features called WFI and WGI combined with clinical features (smoking index, pathological types, cM) were the optimal predictors to predict 2-year OS. The AUC values of the clinical-radiomics model were 0.71 and 0.70 in the training set and validation set, respectively. Conclusions This study demonstrated that planning CT-based radiomics showed the predictability of the radiochemotherapy response and 2-year OS in nonsurgical esophageal carcinoma. The predictive results prior to treatment have the potential to assist physicians in choosing the optimal therapeutic strategy to prolong overall survival.
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Affiliation(s)
- Chao Li
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Radiation Oncology, Shenzhen People’s Hospital, The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yuteng Pan
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xianghui Yang
- Department of Oncology, Changsha Central Hospital, Changsha, Hunan, China
| | - Di Jing
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yu Chen
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chenhua Luo
- Xiangya School of Medicine, Central South University, Hunan, Changsha, China
| | - Jianfeng Qiu
- Medical Engineering and Technology Research Center, Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China Technology, Shenzhen, Guangdong, China
| | - Yongmei Hu
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zijian Zhang
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liting Shi
- Medical Engineering and Technology Research Center, Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China Technology, Shenzhen, Guangdong, China
| | - Liangfang Shen
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Rongrong Zhou
- Department of Oncology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shanfu Lu
- Perception Vision Medical Technologies Co. Ltd, Guangzhou, China
| | - Xiang Xiao
- Hunan Cancer Hospital/the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Hunan, Changsha, China
| | - Tingyin Chen
- Department of Network and Information Center, Xiangya Hospital, Central South University, Hunan, Changsha, China
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Sun J, Huang W, Chen J, Zhang Y. Association of 3D-CRT and IMRT accelerated hyperfractionated radiotherapy with local control rate and 5-year survival in esophageal squamous cell carcinoma patients. Br J Radiol 2022; 95:20211195. [PMID: 35119916 PMCID: PMC10993959 DOI: 10.1259/bjr.20211195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This retrospective study examined the relevance and prognostic factors of whole-course conformal radiotherapy (CRT) and late-course accelerated hyperfractionation radiotherapy (LCAFRT) for esophageal squamous cell carcinoma (ESCC). METHODS A total of 110 patients with ESCC received whole-course CRT and LCAFRT between May 2004 and January 2015. All patients received conventional CRT of 2 Gy per day, up to 30-40 Gy, followed by LCAFRT using reduced fields at 1.5 Gy/fraction twice a day, up to 24-39 Gy, for a total dose of 60-69 Gy. RESULTS The median follow-up was 85 months. The whole groups 1-, 3-, and 5-year survival rates were 81.8%, 46.4%, and 41.8%, respectively. The local control rates for the whole group at 1, 3, and 5 years were 82.7%, 70.0%, and 68.2%, respectively. There were no significant differences among survival rates and local control rates between the 3D-CRT and intensity-modulated radiotherapy (IMRT) groups. The main reactions to acute radiotherapy were acute radiation tracheitis, esophagitis, and pneumonia. The tumor location and TNM stage were independent prognostic factors for overall survival. CONCLUSION The results showed that whole-course CRT and LCAFRT for ESCC can improve survival and local control with a tolerable acute reaction compared to previous studies. Local recurrence and distant metastasis are the main failure modes of treatment. ADVANCES IN KNOWLEDGE Whole-course CRT and LCAFRT for ESCC can improve the survival and local control rate compared with previous studies from the 2DRT era. It might provide another treatment for patients with inoperable ESCC or refusing surgery.
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Affiliation(s)
- Jianyong Sun
- Oncology Department Chaozhou City People’s
Hospital, Guangdong,
China
| | - Weiju Huang
- Oncology Department Chaozhou City People’s
Hospital, Guangdong,
China
| | - Jingbin Chen
- Oncology Department Chaozhou City People’s
Hospital, Guangdong,
China
| | - Yaohong Zhang
- Oncology Department Chaozhou City People’s
Hospital, Guangdong,
China
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Liu Y, Zheng Z, Li M, Zhang Y, Zhao F, Gong H, Lin H, Huang W, Chen X, Xu Z, Li X, Liu W, Cui Y, Zheng A, Li B. Comparison of Concurrent Chemoradiotherapy with Radiotherapy Alone for Locally Advanced Esophageal Squamous Cell Cancer in Elderly Patients: A Randomized, Multicenter, Phase II Clinical Trial. Int J Cancer 2022; 151:607-615. [PMID: 35419831 DOI: 10.1002/ijc.34030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022]
Abstract
This randomized, multicenter, phase II clinical trial was performed to compare the safety and efficacy of concurrent chemoradiotherapy using S-1 (CCRT) with radiotherapy alone (RT) for elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC). All eligible patients were randomly assigned to the CCRT group or the RT group at a 1:1 ratio. The CCRT group received 50.4 Gy radiotherapy concurrent with S-1 and the RT group received 59.4 Gy radiotherapy alone. The primary endpoints were toxicity and the overall response rate (ORR), and the secondary endpoints were overall survival (OS) and progression-free survival (PFS). In total, 157 elderly patients with ESCC were recruited from December 2016 to March 2020. By June 2021, the median follow-up duration had reached 38 months. No grade 5 toxicities occurred in either group and the overall rate of severe toxicities (≥grade 3) was higher in the CCRT group (19.2% to 7.6%; p=0.037), particularly neutropenia (7.7% vs. 1.3%; p=0.06). The CCRT group presented a significantly higher ORR (83.3% vs. 68.4%; p=0.009) and prolonged PFS (25.7 months vs.13.9 months; p=0.026) than the RT group. The median OS was 27.3 months in the CCRT group and 19.1 months in the RT group (p=0.59). For patients older than 70 years with locally advanced ESCC, concurrent chemoradiotherapy with S-1 had tolerable adverse effects and improved ORR and PFS compared with radiotherapy alone.
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Affiliation(s)
- Yanxiao Liu
- Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhiyong Zheng
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Minghao Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaowen Zhang
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Fujun Zhao
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Heyi Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Haiqun Lin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiangming Chen
- Department of Clinical Oncology, Taian City Central Hospital, Taian, Shandong, China
| | - Zhiqiao Xu
- Tumor Diagnosis and Treatment Center, Kaifeng Central Hospital, Kaifeng, Henan, China
| | - Xiaomin Li
- Department of Radiation Oncology, Shanxi cancer hospital, Taiyuan, Shanxi, China
| | - Wenzhi Liu
- Department of Clinical Oncology, Taian City Central Hospital, Taian, Shandong, China
| | - Yanhui Cui
- Radiation Therapy Department, 1 Ward of the First Affiliated Hospital of Xinxiang, Weihui, Henan, China
| | - Anping Zheng
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Holakouie-Naieni K, Mansournia MA, Doosti-Irani A, Rahimi-Foroushani A, Haddad P. Treatment-related complications in patients with esophageal cancer: A systematic review and network meta-analysis. Surgeon 2021; 19:37-48. [PMID: 32209308 DOI: 10.1016/j.surge.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/22/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The aim of this review was to compare the available treatments of esophageal cancer, in terms of pulmonary, cardiovascular complications, anastomotic leakage, and esophagitis after treatment in patients with esophageal squamous cell carcinoma (SCC). METHODS Medline, Web of Science, Scopus, the Cochrane Library and Embase were searched. The randomized controlled trials (RCT) that had compared the treatment -related complications of treatments for esophageal SCC were included. We included 39 randomized control trials in a network meta-analysis. The Chi2-test was used to assess of heterogeneity. The loop-specific and design-by-treatment interaction methods were used for assessment of consistency assumption. The risk ratio with 95% confidence interval (CI) was used to report the effect-sizes in the network meta-analysis. RESULTS The pulmonary complication, cardiac complication, anastomotic leakage, and esophagitis were reported in 31, 11, 17, and 15 RCTs respectively. Video-assisted thoracoscopy + laparoscopy (VATS) was rank as the first and second treatment in terms of lower risk for pulmonary complication and anastomotic leakage. There was no statistically significant difference between treatments in terms of lower risk of cardiovascular complications. However, Surgery + Cisplatin + Fluorouracil (SCF) was ranked as better treatment. 3-dimensional conformal radiotherapy + Docetaxel + Cisplatin (3DCRTDC) was the best treatment in terms of lower risk for esophagitis. CONCLUSION According to the results of this study, it seems the risk of pulmonary, cardiovascular, anastomotic leakage and esophagitis complications for VATS, SCF, surgery + radiotherapy (SRT), and 3DCRTDC was lower than other treatments respectively in the networks.
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Affiliation(s)
- Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Doosti-Irani
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi-Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Peiman Haddad
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Luo H, Wei S, Wang X, Liu R, Zhang Q, Yang Z, Li Z, Wei X, Qi Y, Xu L. Late-course accelerated Hyperfractionation vs. Conventional Fraction Radiotherapy under precise technology plus Concurrent Chemotherapy for Esophageal Squamous Cell Carcinoma: comparison of efficacy and side effects. J Cancer 2020; 11:3020-3026. [PMID: 32226517 PMCID: PMC7086241 DOI: 10.7150/jca.41012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/04/2020] [Indexed: 12/24/2022] Open
Abstract
Background: The accelerated reproliferation of esophageal squamous cell carcinoma (ESCC) after radiation contributes to conventional fraction radiotherapy (CFRT) failure. Late course accelerated hyperfractionated radiotherapy (LCAHFRT) can improve the long-term survival of esophageal cancer patients in China but is associated with a high rate of side effects due to the large exposure field of two-dimensional treatment and drug toxicity. Intensity-modulated radiotherapy (IMRT) can increase the tumor dose while decreasing the normal tissue dose. Therefore, we compared the outcomes and side effects of LCAHFIMRT plus concurrent chemotherapy (CT) and CFIMRT plus CT for ESCC. Methods and Materials: Between 2013 and 2016, 114 eligible patients with ESCC were recruited and randomly assigned to receive LCAHFIMRT+CT (58 patients) or CFIMRT+CT (56 patients) by a linear accelerator (6-MV X-ray) under image guidance. Two cycles of CT with cisplatin and docetaxel were also administered. Results: The complete response (CR) rates were 79.3% and 61.8% in the LCAHFIMRT+CT and CFIMRT+CT groups, respectively (P=0.041). The median duration of local control times was 31.0±1.9 months for the LCAHFIMRT+CT group and 24.0±3.3 months for the CFIMRT+CT groups,and the 1-, 2-, and 3-year local control rates were 86.2%, 63.8%, and 41.4% and 85.7%, 51.8%, and 32.1% for the LCAHFIMRT+CT and CFIMRT+CT groups (P=0.240), respectively. The median survival times were 34.0±1.1 months for the LCAHFIMRT+CT group and 28.0.0±3.7 months for the CFIMRT groups,and the 1-, 2-, and 3-year survival rates were 87.9%, 74.1%, and 44.8% and 87.5%, 60.7%, and 39.3% for the LCAHFIMRT+CT and CFIMRT+CT groups, respectively (P=0.405). The incidence of side effects was not significantly different between the two groups. Local recurrence and uncontrolled disease resulted in more deaths in the CFIMRT+CT group than in the LCAHFIMRT+CT group (58.9% vs. 39.7%) (P=0.040). Conclusion: For ESCC patients, LCAHFRT delivered by image-guided intensity-modulated techniques Plus Concurrent Chemotherapy with cisplatin and docetaxel keeps safety and high CR rate, as well as local control and long-term survival rates.
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Affiliation(s)
- Hongtao Luo
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.,Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Shihong Wei
- Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Xiaohu Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China.,Gansu Provincial Cancer Hospital, Lanzhou 730050, China.,Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Ruifeng Liu
- Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Qiuning Zhang
- Lanzhou Heavy Ion Hospital, Lanzhou 730000, China.,Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China
| | - Zhen Yang
- The Basic Medical College of Lanzhou University, Lanzhou 730000, China
| | - Zheng Li
- Lanzhou Heavy Ion Hospital, Lanzhou 730000, China
| | - Xiyi Wei
- Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Yuexiao Qi
- Gansu Provincial Cancer Hospital, Lanzhou 730050, China
| | - Lijun Xu
- Gansu Provincial Cancer Hospital, Lanzhou 730050, China
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Cai XW, Zeng Y, Feng W, Liu MN, Yu W, Zhang Q, Liu J, Wang JM, Lv CX, Fu XL. 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. Dis Esophagus 2019; 32:5373138. [PMID: 30855089 DOI: 10.1093/dote/doz013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 12/11/2022]
Abstract
This study compares the outcomes of different postoperative radiation fields for locoregionally advanced thoracic esophageal squamous cell carcinoma (ESCC) patients. This is a multi-institution randomized phase II trial and noninferior study. Patients with ESCC who had undergone esophagectomy (stage T3-4N0-3M0) were enrolled and randomized into the large-field irradiation arm (LFI; tumor bed and elective lymph node region) and small-field irradiation arm (SFI; tumor bed only). The primary endpoint was whether the disease-free survival (DFS) of SFI was not inferior to LFI. The secondary endpoint was to evaluate the rationality of the radiation target volume by analyzing failure patterns. One hundred twenty-one patients (64 patients for LFI and 57 patients for SFI, respectively) were eligible in this mid-time analysis. The 1- and 3-year DFS was 79.9%, 46.2% for LFI and 67.6%, 44.3% for SFI, respectively (P = 0.414). The locoregional recurrence-free survival (LRFS) of LFI was significantly better than that of SFI (P = 0.003). However, there were no significant differences in the distant metastasis-free survival and overall survival between the two arms (P = 0.332, P = 0.405, respectively). The failure patterns of the two arms were significantly different (P = 0.002). For pT3-4N0-3M0 ESCC patients, postoperative radiotherapy with SFI showed a similar survival outcome to LFI. However, the LRFS of patients with SFI was worse than that of patients with LFI.
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Affiliation(s)
- X-W Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Y Zeng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - W Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - M-N Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - W Yu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Q Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - J Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - J-M Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - C-X Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University
| | - X-L Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
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9
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Zhao K. Reply to A. Adenis et al. J Clin Oncol 2019; 37:2380-2381. [PMID: 31356141 DOI: 10.1200/jco.19.01423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Kuaile Zhao
- Kuaile Zhao, MD, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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10
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Chen Y, Ye J, Zhu Z, Zhao W, Zhou J, Wu C, Tang H, Fan M, Li L, Lin Q, Xia Y, Li Y, Li J, Jia H, Lu S, Zhang Z, Zhao K. Comparing Paclitaxel Plus Fluorouracil Versus Cisplatin Plus Fluorouracil in Chemoradiotherapy for Locally Advanced Esophageal Squamous Cell Cancer: A Randomized, Multicenter, Phase III Clinical Trial. J Clin Oncol 2019; 37:1695-1703. [PMID: 30920880 PMCID: PMC6638596 DOI: 10.1200/jco.18.02122] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This trial aimed to assess the efficacy and safety of the paclitaxel plus fluorouracil regimen versus the cisplatin plus fluorouracil regimen in definitive concurrent chemoradiotherapy (dCRT) in patients with locally advanced esophageal squamous cell carcinoma (ESCC). PATIENTS AND METHODS Patients with locally advanced ESCC were enrolled and randomly assigned to either the paclitaxel plus fluorouracil group or the cisplatin plus fluorouracil group. The patients in the paclitaxel plus fluorouracil group were treated with paclitaxel and fluorouracil one cycle per week in dCRT for five cycles followed by paclitaxel and fluorouracil one cycle per month in consolidation chemotherapy for two cycles. The patients in the cisplatin/5-fluorouracil group were treated with cisplatin and fluorouracil one cycle per month in dCRT for two cycles followed by two cycles in consolidation chemotherapy. The radiotherapy dose was 61.2 Gy delivered in 34 fractions. The primary end point was 3-year overall survival (OS). RESULTS Four hundred thirty-six patients with ESCC in six centers were recruited at a 1:1 ratio between April 2012 and July 2015. The median follow-up of the surviving patients was 48.7 months (interquartile range, 42.6-60.9). The 3-year OS was 55.4% in the paclitaxel plus fluorouracil group and 51.8% in the cisplatin plus fluorouracil group (hazard ratio, 0.905 [95% CI, 0.698 to 1.172]; P = .448). The 3-year progression-free survival was also not significantly different between the paclitaxel plus fluorouracil group and the cisplatin plus fluorouracil group (43.7% v 45.5%, respectively; hazard ratio, 0.973 [95% CI, 0.762 to 1.243]; P = .828). Compared with the cisplatin plus fluorouracil group, the paclitaxel plus fluorouracil group had significantly lower incidences of acute grade 3 or higher anemia, thrombocytopenia, anorexia, nausea, vomiting, and fatigue (P < .05), but higher incidences of acute grade 3 or higher leukopenia, radiation dermatitis, and radiation pneumonitis (P < .05). CONCLUSION The paclitaxel plus fluorouracil regimen did not significantly prolong the OS compared with the standard cisplatin plus fluorouracil regimen in dCRT in patients with locally advanced ESCC.
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Affiliation(s)
- Yun Chen
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jinjun Ye
- 2 Jiangsu Cancer Hospital, Nanjing, China
| | - Zhengfei Zhu
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Weixin Zhao
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jialiang Zhou
- 3 Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Chaoyang Wu
- 4 Zhenjiang First People's Hospital, Zhenjiang, China
| | - Huarong Tang
- 4 Zhenjiang First People's Hospital, Zhenjiang, China
| | - Min Fan
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ling Li
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qin Lin
- 5 The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yi Xia
- 6 Fudan University Shanghai Cancer Center Minhang Branch Hospital, Shanghai, China
| | - Yunhai Li
- 6 Fudan University Shanghai Cancer Center Minhang Branch Hospital, Shanghai, China
| | - Jiancheng Li
- 7 Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Huixun Jia
- 1 Fudan University Shanghai Cancer Center, Shanghai, China.,8 Shanghai General Hospital, Shanghai, China
| | - Saiquan Lu
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhen Zhang
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
| | - Kuaile Zhao
- 1 Fudan University Shanghai Cancer Center, Shanghai, China
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11
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Fan X, Wu J, Wang H, Liang F, Jiang G, Wu K. Three-dimensional conformal radiation therapy alone for esophageal squamous cell carcinoma: 10-year survival outcomes. Thorac Cancer 2019; 10:519-525. [PMID: 30648821 PMCID: PMC6397900 DOI: 10.1111/1759-7714.12968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/15/2018] [Accepted: 12/16/2018] [Indexed: 12/21/2022] Open
Abstract
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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Affiliation(s)
- Xing‐Wen Fan
- Department of Radiation OncologyFudan University, Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Jun‐Lan Wu
- Department of OncologyShanghai Armed Police Corps HospitalShanghaiChina
| | - Hong‐Bing Wang
- Department of Radiation OncologyFudan University, Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Fei Liang
- Clinical Statistics CenterFudan University, Shanghai Cancer CenterShanghaiChina
| | - Guo‐Liang Jiang
- Department of Radiation OncologyFudan University, Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
| | - Kai‐Liang Wu
- Department of Radiation OncologyFudan University, Shanghai Cancer CenterShanghaiChina
- Department of OncologyShanghai Medical College, Fudan UniversityShanghaiChina
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12
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The role of definitive chemoradiation in patients with non-metastatic oesophageal cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:53-59. [PMID: 30551857 DOI: 10.1016/j.bpg.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
Definitive chemoradiation (dCRT) is a curative treatment option for patients with oesophageal cancer. It is effective in both adenocarcinoma and squamous cell carcinoma. However, locoregional control is less after dCRT compared to preoperative CRT (pCRT) followed by surgery. Also, overall survival is lower compared to pCRT followed by surgery, which can only partly be explained by a negative selection of patients. The optimal dose of radiotherapy remains to be determined, but dose escalation above 50.4Gy might be beneficial. Cisplatinum/5-FU is the most applied concurrent chemotherapy, but carboplatin/paclitaxel seems equally effective with less toxicity. The addition of 5-FU to a taxane and platinum seems promising. Accelerated fractionation and addition of cetuximab did not improve results. dCRT is a successful treatment for regional lymph node recurrences, but less so for recurrences at the anastomotic site. Re-irradiation after prior curative radiotherapy yields poor results. dCRT can be safely used in carefully selected elderly.
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13
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Liu Y, Kou C, Bai W, Liu X, Song Y, Zhang L, Wang M, Zhang Y, You Y, Yin Y, Jiang X, Xin Y. Altered fractionation radiotherapy with or without chemotherapy in the treatment of head and neck cancer: a network meta-analysis. Onco Targets Ther 2018; 11:5465-5483. [PMID: 30233208 PMCID: PMC6129020 DOI: 10.2147/ott.s172018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES A Bayesian network meta-analysis (NMA) was conducted in patients with head and neck cancers (HNCs) to estimate the efficacy and safety of treatment with conventional fractionation radiotherapy (CF), conventional fractionation chemoradiotherapy (CF_CRT), hyperfractionated radiotherapy (HF), hyperfractionated chemoradiotherapy (HF_CRT), accelerated fractionation radiotherapy, accelerated fractionation chemoradiotherapy, accelerated hyperfractionated radiotherapy (HART) or accelerated hyperfractionated chemoradiotherapy (HACRT) to identify superior treatments to aid in clinical decisions. METHODS PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for potentially eligible randomized controlled trials up to December 2016. Overall survival (OS), disease-free survival (DFS) and locoregional control (LRC) were considered efficacy outcomes, whereas acute toxicity and late toxicity on skin and mucosa were considered safety outcomes. The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment in each index. RESULTS Data from 72 trials with 21,868 participants were included in the analysis. Concerning OS, all treatments were associated with a significant advantage compared to CF alone, with HR effect sizes ranging from 0.64 to 0.83, and HACRT was significantly more effective than all the other treatments. The network comparisons of both HACRT vs HART and HF_CRT vs HF demonstrated a higher OS benefit, with an HR of 0.78 (95% credible interval [CrI]: 0.64-0.95) and 0.78 (95% CrI: 0.61-0.99), respectively. The results of SUCRA indicated that HACRT had the best ranking for OS and LRC, HF_CRT for DFS, HART for acute and late skin toxicity, CF_CRT for acute mucosal toxicity and HF_CRT for late mucosal toxicity. CONCLUSION The NMA results support the notion that HACRT is the preferable treatment modality for HNCs because it has better rankings in all three efficacy indexes, although it does present a high risk of acute mucosal toxicity.
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Affiliation(s)
- Yingyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wei Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yan Song
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lili Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Mohan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yangyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yueyue You
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue Yin
- Department of Radiation Oncology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Jiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, Jilin, China,
| | - Ying Xin
- Department of Pathology, School of Basic Medicine, Jilin University, Changchun, Jilin, China,
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14
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Doosti-Irani A, Holakouie-Naieni K, Rahimi-Foroushani A, Mansournia MA, Haddad P. A network meta-analysis of the treatments for esophageal squamous cell carcinoma in terms of survival. Crit Rev Oncol Hematol 2018; 127:80-90. [PMID: 29891115 DOI: 10.1016/j.critrevonc.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/18/2018] [Accepted: 05/09/2018] [Indexed: 01/30/2023] Open
Abstract
We aimed to compare treatments for patients with esophageal squamous cell carcinoma (SCC) in terms of survival. Medline, Web of Science, Scopus, the Cochrane Library and Embase were searched. Randomized controlled trials (RCT) that had compared esophageal SCC treatments were included. The hazard ratio (HR) with 95% credible interval (CrI) was used to summarize the effect measures in the Bayesian network meta-analysis. Out of 23,256 references, 43 RCTs with 34 treatments were included. Carboplatin and paclitaxel plus radiotherapy plus surgery (carbo-pacli + RT + S) compared with surgery alone decreased risk of death (HR = 0.49; 95% CrI: 0.26, 0.90). The HRs for carbo-pacli + RT + S versus surgery plus cisplatin and fluorouracil and surgery plus cisplatin and vindesine were 0.44 (0.22, 0.86) and 0.41 (0.20, 0.83), respectively. Among all treatments in network, carbo-pacli + RT + S ranked as first treatment. It seems carbo-pacli + RT + S was a better treatment among available treatments in network in terms of survival in patients with esophageal SCC.
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Affiliation(s)
- Amin Doosti-Irani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Rahimi-Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Peiman Haddad
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Han J, Zhu W, Yu C, Zhou X, Li T, Zhang X. Clinical Study of Concurrent Chemoradiotherapy or Radiotherapy Alone for Esophageal Cancer Patients with Positive Lymph Node Metastasis. TUMORI JOURNAL 2018; 98:60-5. [DOI: 10.1177/030089161209800108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Esophageal cancer patients with pathologic lymph node involvement generally have a poor prognosis. Many randomized controlled trials have not achieved consistent results similar to those of the RTOG8501 trial, and the long-term survival rate has not increased. The present study aimed to compare the efficacy and toxic side effects of concurrent chemoradiotherapy and radiotherapy alone to treat N1 esophageal carcinoma. Methods and Study Design A total of 130 N1 esophageal carcinoma patients were enrolled and randomly divided into two groups: concurrent chemoradiotherapy group (n = 65) and radiotherapy group (n = 65). Both groups received three-dimensional conformal radiotherapy with a total dose of 64–66 Gy. Meanwhile, to the concurrent chemoradiotherapy group, an additional chemotherapy protocol (nedaplatin, 20 mg/m2/d, 5-FU, 500 mg/m2/d for four days) was given from day 1, and such treatment was repeated until day 29. From day 21 after radiotherapy, two cycles of a consolidated chemotherapy protocol were given at an interval of 28 days. Results The survival rates at one, two, and three years were 72.3%, 55.3%, and 40% in the concurrent chemoradiotherapy group, respectively, and 75.3%, 38.5%, and 18.5% in the radiotheray group (P = 0.007), respectively. The survival rates of the patients in the concurrent chemoradiotherapy group who completed one to two cycles and three to four cycles at one, two, and three years were 70%, 53.3%, and 30%, and 74.2%, 57.1%, 48.6% (P = 0.128), respectively. Three-year distant metastasis rates were 10.7% in the concurrent chemoradiotherapy group and 16.9% in the radiotherapy group. Acute toxicity in the concurrent chemoradiotherapy group was higher than in the radiotherapy group. Late toxic side effects were similar in the two groups. Conclusions Compared with radiotherapy alone, concurrent chemoradiotherapy in the treatment of esophageal carcinoma with local lymph node enlargement can improve the three-year survival rate. Moreover, completion of three to four cycles of chemotherapy may have better efficacy than one to two cycles.
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Affiliation(s)
- Jihua Han
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Weiguo Zhu
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Changhua Yu
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Xilei Zhou
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Tao Li
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Xiaoye Zhang
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
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16
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Luo Y, Mao Q, Wang X, Yu J, Li M. Radiotherapy for esophageal carcinoma: dose, response and survival. Cancer Manag Res 2017; 10:13-21. [PMID: 29343986 PMCID: PMC5749557 DOI: 10.2147/cmar.s144687] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Esophageal cancer (EC) is an extremely aggressive, lethal malignancy that is increasing in incidence worldwide. At present, definitive chemoradiotherapy is accepted as the standard treatment for locally advanced EC. The EC guidelines recommend a radiation dose of 50.4 Gy for definitive treatment, yet the outcomes for patients who have received standard-dose radiotherapy remain unsatisfactory. However, some studies indicate that a higher radiation dose could improve local tumor control, and may also confer survival benefits. Some studies, however, suggest that high-dose radiotherapy does not bring survival benefit. The available data show that most failures occurred in the gross target volume (especially in the primary tumor) after definitive chemoradiation. Based on those studies, we hypothesize that at least for some patients, more intense local therapy may lead to better local control and survival. The aim of this review is to evaluate the radiation dose, fractionation strategies, and predictive factors of response to therapy in functional imaging for definitive chemoradiotherapy in esophageal carcinoma, with an emphasis on seeking the predictive model of response to CRT and trying to individualize the radiation dose for EC patients.
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Affiliation(s)
- Yijun Luo
- Department of Oncology, The People's Hospital of Jiangxi, Nanchang
| | - Qingfeng Mao
- School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences.,Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Xiaoli Wang
- Department of Oncology, The People's Hospital of Jiangxi, Nanchang
| | - Jinming Yu
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Minghuan Li
- Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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17
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Li X, Zhao J, Liu M, Zhai F, Zhu Z, Yu F, Zhang M, Han L, Zhao Y, Wang H. Determination of radiotherapeutic target zones for thoracic esophageal squamous cell cancer with lower cervical lymph node metastasis according to CT-images. Oncotarget 2017; 7:35865-35873. [PMID: 27147581 PMCID: PMC5094969 DOI: 10.18632/oncotarget.9094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/16/2016] [Indexed: 11/25/2022] Open
Abstract
Esophageal squamous cell carcinoma (ESCC) is a leading cause of cancer-related deaths worldwide. And radical synchronized chemoradiotherapy has become an important treatment measures for this disease. It is necessary to define the therapeutic target zone based on computer tomography(CT)-images for precise radiotherapy. Therefore, we retrospectively analyzed the regularity of lymph node metastasis in lower cervical section of thoracic esophageal cancer based on CT-images and discussed the range of radiotherapy in supraclavicular zone. The lower cervical lymphatic drainage area was divided into cervical tracheoesophageal groove (CTG), medial supraclavicular zone (MSC zone) and lateral supraclavicular zone (LSC zone) based on CT-images. We found that the rate of lymph node metastasis to medial CTG and MSC zone was relatively high. And rate of lymph node metastasis to the above two zones from middle thoracic section was on an increasing trend with the progress of T stage. Patients at stage T3 and T4 with lymph node metastasis in tracheoesophageal groove in middle thoracic section showed a higher rate of lymph node metastasis in MSC zone. These results demonstrated that the CTG and MSC zone should be clinically included in the supraclavicular target zone for radical radiotherapy, and the T-stage and tumor location should be considered simultaneously.
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Affiliation(s)
- Xingde Li
- Cangzhou Central Hospital, Cangzhou, China
| | - Jin Zhao
- Cangzhou Central Hospital, Cangzhou, China
| | - Ming Liu
- Hospital No. 3 of Hebei Medical University, Hebei, China
| | - Fushan Zhai
- Hospital No. 3 of Hebei Medical University, Hebei, China
| | - Zhengfei Zhu
- Tumor Hospital of Fudan University, Shanghai, China
| | - Feng Yu
- People's Hospital of Qidong City, Nantong, China
| | | | - Lijie Han
- Cangzhou Central Hospital, Cangzhou, China
| | - Yue Zhao
- Cangzhou Central Hospital, Cangzhou, China
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18
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So B, Marcu LG, Olver I, Gowda R, Bezak E. Cocktail without hangover: in search for the optimal chemotherapy in the combined management of non-operable esophageal carcinomas. Acta Oncol 2017; 56:899-908. [PMID: 28375694 DOI: 10.1080/0284186x.2017.1307518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The worldwide incidence of esophageal cancer has greatly increased over the past few decades making it the sixth deadliest cancer. The disease is often detected in advanced stages when surgery is no longer an option. The standard treatment in these situations is combined chemoradiotherapy, by employing drug cocktails that lead to optimal treatment outcomes both from the perspective of tumor control and normal tissue toxicity. METHODS The aim of this work was to collate the existing trials and clinical studies reported on non-operable esophageal cancer and to analyze the results based on treatment outcomes after various drug combinations. RESULTS Of all drug combinations, cisplatin/5-FU is the most well established chemotherapy regimen for esophageal cancer as both neoadjuvant therapy, an alternative option to surgery, and for palliative purposes. Although this regimen is associated with the most toxicity, it also appears to have the best survival benefit and relief of symptoms. CONCLUSIONS More research is warranted to further increase the therapeutic ratio in non-operable esophageal cancers.
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Affiliation(s)
- Bianca So
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Loredana G. Marcu
- Department of Physics, Faculty of Science, University of Oradea, Oradea, Romania
- School of Physical Sciences, University of Adelaide, Adelaide, Australia
| | - Ian Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, Australia
- Department of Physics, Faculty of Science, University of Oradea, Oradea, Romania
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Zhang Y, Liu J, Zhang W, Deng W, Yue J. Treatment of esophageal cancer with radiation therapy -a pan-Chinese survey of radiation oncologists. Oncotarget 2017; 8:34946-34953. [PMID: 28430590 PMCID: PMC5471024 DOI: 10.18632/oncotarget.16858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/28/2017] [Indexed: 01/04/2023] Open
Abstract
Lots of controversies were found about the treatment in relation to radiation therapy (RT) for esophageal squamous cell carcinoma (ESCC). We designed a questionnaire of these controversies to do a pan-Chinese survey of radiation oncologists (ROs). For operable ESCC, 53% ROs chose surgery plus postoperative chemoradiotherapy (CRT), while 40% chose preoperative CRT plus surgery. For target volume of postoperative RT, most ROs (92%) would delineate tumor bed plus involved lymph nodes region before surgery. For definitive RT, most ROs (81%) would give patients higher RT dose to 60-65Gy. For radiation target volume, most ROs would give patients prophylactic irradiation of the bilateral superclavicular-lymph nodes region for cervical ESCC (93%), and the left gastric lymph nodes region for lower thoracic ESCC (72%). For the treatment of mediastinal lymph nodes, 72% ROs preferred elective nodal irradiation, while 28% did the involved nodal irradiation. For concurrent chemotherapy regimen, PF (5-Fu + cisplatin) and TP (cisplatin + paclitaxel) were used widely (49% and 46%, respectively). During simulation, four-dimensional computer tomography (4D CT) was not widely used (48%), even for cervical or lower thoracic ESCC (52%). For daily RT delivery, only 66% ROs would perform imaging guidance RT daily. In summary, more controversies existed in the treatment of ESCC with RT in China, including treatment strategy, radiation dose and target contour. Future goals include standardization of treatment strategy, radiation dose, and target contour, and application of 4D CT and daily imaging guidance, and pursuit of randomized trials in Chinese population.
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Affiliation(s)
- Yun Zhang
- School of Medicine and Life Sciences, University of Jinan Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jing Liu
- Graduate Education Center, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | | | - Weiye Deng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health at Houston, Houston, Texas, USA
| | - Jinbo Yue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Li Z, Zhang P, Ma Q, Wang D, Zhou T. Cisplatin-based chemoradiotherapy with 5-fluorouracil or pemetrexed in patients with locally advanced, unresectable esophageal squamous cell carcinoma: A retrospective analysis. Mol Clin Oncol 2017; 6:743-747. [PMID: 28515926 DOI: 10.3892/mco.2017.1222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/20/2016] [Indexed: 12/13/2022] Open
Abstract
Treatment with 5-fluorouracil (5-FU) and cisplatin (PF regimen) remains the most frequently used chemotherapy for esophageal squamous cell carcinoma (SCC). The aim of the present study was to assess the efficacy and safety of pemetrexed/cisplatin (PP regimen) as definitive treatment compared with PF. A total of 60 patients with locally advanced, unresectable SCC of the esophagus receiving concomitant chemoradiotherapy were recruited in this study; of those patients, 29 received four cycles (two concomitant and two post-radiotherapy) of the PF regimen (arm A, cisplatin 25 mg/m2/day i.v. on days 1-3 plus 5-FU 800 mg/m2/24 h by continuous infusion on days 1-5) and 31 received four cycles of the PP regimen (arm B, cisplatin 25 mg/m2/day i.v. on days 1-3 plus pemetrexed 500 mg/m2 on day 1). All the patients in both arms received a total radiation dose of 59.6 Gy. The two arms were well-matched for age, gender, Karnofsky performance status, TNM stage, tumor location and length. The overall response rate was 89.7% in arm A vs. 93.5% in arm B (P>0.05). The median overall survival was 26.1 months [95% confidence interval (CI): 15.3-36.8 months] in arm A vs. 28.7 months (95% CI: 9.4-48.0 months) in arm B (P>0.05). Severe esophagitis occurred in 31.0% (9/29) of the patients in arm A vs. 12.9% (4/31) of the patients in arm B; the difference was statistically significant (P=0.036). Grade 3/4 leukopenia and thrombocytopenia occurred in 4 (13.8%) and 1 (3.4%) patients, respectively, in arm A vs. 12 (38.7%) and 6 (19.4%) patients, respectively, in arm B; the differences were statistically significant (P=0.029 and 0.041, respectively). Therefore, chemoradiotherapy with the PP regimen achieved therapeutic results comparable with those of the PF regimen; in terms of toxicity, the incidence of hematological toxicity was higher and that of esophagitis was lower with the PP regimen.
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Affiliation(s)
- Zengyun Li
- Department of Oncology, Laiwu Municipal Hospital of Traditional Chinese Medicine, Laiwu, Shandong 271100, P.R. China
| | - Peiliang Zhang
- Department of Radiation Oncology, Yishui Central Hospital, Yishui, Shandong 276400, P.R. China
| | - Qingtong Ma
- Department of Oncology, Laiwu Municipal Hospital of Traditional Chinese Medicine, Laiwu, Shandong 271100, P.R. China
| | - Dongqing Wang
- Department of Radiation Oncology, Shandong Tumor Hospital, Jinan, Shandong 250117, P.R. China
| | - Tao Zhou
- Department of Radiation Oncology, Shandong Tumor Hospital, Jinan, Shandong 250117, P.R. China
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21
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So B, Marcu L, Olver I, Gowda R, Bezak E. Oesophageal cancer: Which treatment is the easiest to swallow? A review of combined modality treatments for resectable carcinomas. Crit Rev Oncol Hematol 2017; 113:135-150. [PMID: 28427503 DOI: 10.1016/j.critrevonc.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 12/17/2016] [Accepted: 03/08/2017] [Indexed: 01/31/2023] Open
Abstract
Oesophageal cancer is a relatively uncommon malignancy, but with poor prognosis. Despite several treatment options that are available, the 5-year survival rates rarely exceed 40%. This review discusses the main challenges of oesophageal cancer, the available treatment options, and the most effective treatment in terms of overall survival. The outcomes of clinical trials show that neo-adjuvant chemo-radiotherapy using cisplatin and 5-fluorouracil followed by oesophagectomy results in the greatest survival. However, the optimal chemotherapy and radiotherapy schedule remains unclear. There is no satisfactory treatment to date, particularly for patients with co-morbidities or advanced tumours.
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Affiliation(s)
- Bianca So
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Loredana Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania; School of Physical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Ian Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; School of Physical Sciences, University of Adelaide, Adelaide, SA, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
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22
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Deng JY, Wang C, Shi XH, Jiang GL, Wang Y, Liu Y, Zhao KL. 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 trials. Dis Esophagus 2016; 29:1121-1127. [PMID: 26663710 DOI: 10.1111/dote.12435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We conducted a retrospective analysis to assess the toxicity and long-term survival of esophageal squamous cell carcinoma patients treated with three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) versus conventional two-dimensional radiotherapy (2DRT). All data in the present study were based on four prospective clinical trials conducted at our institution from 1996 to 2004 and included 308 esophageal squamous cell carcinoma patients treated with 2DRT or 3DCRT/IMRT. Based on the inclusion and exclusion criteria, 254 patients were included in the analysis. Of these patients, 158 were treated with 2DRT, whereas 96 were treated with 3DCRT/IMRT. The rates of ≥Grade3 acute toxicity of the esophagus and lung were 11.5% versus 28.5% (P = 0.002) and 5.2% versus 10.8% (P = 0.127) in the 3DCRT/IMRT and 2DRT groups, respectively. The incidences of ≥Grade 3 late toxicity of the esophagus and lungs were 3.1% versus 10.7% (P = 0.028) and 3.1% versus 5.7% (P = 0.127) in the 3DCRT/IMRT and 2DRT groups, respectively. The 1-year, 3-year and 5-year estimated overall survival rates were 81%, 38% and 34% in the 3DCRT/IMRT group and 79%, 44% and 31% in the 2DRT group, respectively (P = 0.628). The 1-year, 3-year and 5-year local control rates were 88%, 71% and 66% in the 3DCRT/IMRT group and 84%, 66% and 60% in the 2DRT group, respectively (P = 0.412). Fewer incidences of acute and late toxicities were observed in esophageal squamous cell carcinoma patients treated with 3DCRT/IMRT compared with those treated with 2DRT. No significant survival benefit was observed with the use of 3DCRT/IMRT.
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Affiliation(s)
- J-Y Deng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - C Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - X-H Shi
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - G-L Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Y Wang
- Department of Radiation Oncology, Shanghai Gamma-Knife Hospital, Shanghai, China
| | - Y Liu
- Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - K-L Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Jia XJ, Huang JZ. Clinical Study on Lobaplatin Combined with 5-Fu and Concurrent Radiotherapy in Treating Patients with Inoperable Esophageal Cancer. Asian Pac J Cancer Prev 2016; 16:6595-7. [PMID: 26434880 DOI: 10.7314/apjcp.2015.16.15.6595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate short- and long-term treatment effects and side reactions of lobaplatin plus 5-Fu combined and concurrent radiotherapy in treating patients with inoperable middle-advanced stage esophageal cancer. METHODS Sixty patients with middle-advanced stage esophageal squamous cell cancer were retrospectively analyzed. All patients were administered lobaplatin (50 mg intravenously) for 2 h on day 1, and 5-Fu (500 mg/m2) injected intravenously from day 1 to 5 for 1 cycle, in an interval of 21 days for totally 4 cycles. At the same time, late-course accelerated hyperfractionated three-dimensional conformal radiotherapy was performed. Patients were firstly treated with conventional fractionated irradiation (1.8 Gy/d, 5 times/week, a total of 23 treatments, and DT41.4 Gy), and then treated with accelerated hyperfractionated irradiation (1.5 Gy, 2 times/d, a total of 27 Gy in 9 days, an entire course of 6-7 weeks, and DT 68.4 Gy). RESULTS All patients completed treatment, including 10 complete response (CR), 41 partial response (PR), 7 stable disease (SD), and 2 progressive disease (PD). The total effective rate was 85.0% (51/60). Thirty-nine patients had an increased KPS score. One-, 2-, and 3-year survival rates were 85.3%, 57.5%, and 41.7%, respectively. The median survival time was 27 months. The adverse reactions included myelosuppression, which was mainly degreeI and II. The occurrence rate of radiation esophagitis was 17.5%. No significant hepatic or renal toxicity was observed. CONCLUSION Lobaplatin plus 5-Fu combined with concurrent radiotherapy is safe and effective in treating patients with middle-advanced stage esophageal cancer. However, this result warrants further evaluation by randomized clinical studies.
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Affiliation(s)
- Xiao-Jing Jia
- Department of Tumor Radiationtherapy, the Second Hospital of Jilin University, Changchun, China E-mail :
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Li M, Fu C, Zhang W, Huang W, Wang Z, Zhou T, Lin H, Li B. Phase I study of concurrent selective lymph node late-course accelerated hyperfractionated radiotherapy and S-1 plus cisplatin for locally advanced oesophageal squamous cell carcinoma. Br J Radiol 2016; 89:20150476. [PMID: 26891913 DOI: 10.1259/bjr.20150476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This Phase I study aimed to assess the safety and efficacy of concurrent selective lymph node (SLN) late-course accelerated hyperfractionated (LCAF) intensity-modulated radiotherapy (IMRT) and S-1 plus cisplatin (CDDP) for the locally advanced oesophageal squamous-cell carcinoma (ESCC). METHODS The total dose of SLN LCAF IMRT was 59.6 Gy/34 fractions in 5.4 weeks. The concurrent chemotherapy (CCRT) was administered as follows: CDDP 25 mg m(-2) on Days 1-3 and Days 22-24; S-1 was applied in a de-escalating dosage with a decrement of 10 mg m(-2) per day, from its full dose level of 80 mg m(-2), orally twice daily on Days 1-14 and Days 22-35. We inferred the maximum-tolerated dose (MTD), dose-limiting toxicities (DLTs) and recommended dose, according to adverse reaction during CCRT. RESULTS Totally, 15 patients with ESCC with T2-4N0-1M0-1a were enrolled in Dose Level 1 (80 mg m(-2)). In the initial five patients, two patients developed DLTs. As MTD was not reached, five additional patients were treated with the same dose level, and DLTs occurred in only one patient. Similar results were found in the last five patients. After CCRT, the objective response rates were 100% for primary tumours and 86.2% for metastatic lymph nodes, respectively. Totally, the observed Grade 3 toxicities during CCRT were leukopenia (20%), neutropenia (20%) and dermatitis (13.3%), and no Grade 4 toxicity occurred. The Kaplan-Meier-estimated overall and progression survival rates were 86.7% and 66.7% (1 year), 73.3% and 60% (2 years) and 73.3% and 60% (3 years). CONCLUSION The concurrent SLN LCAF IMRT and chemotherapy with S-1 and CDDP was well tolerated and showed promising efficacy. The dose of S-1 in this regimen was recommended with 80 mg m(-2) orally twice daily on Days 1-14 and Days 22-35. ADVANCES IN KNOWLEDGE CCRT with S-1 plus CDDP exhibited encouraging results with milder toxicities, high objective response rates and ideal overall survival time.
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Affiliation(s)
- Miaomiao Li
- 1 Shandong Medical College, Jinan, Shandong Province, China
| | - Chengrui Fu
- 2 Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong province, China
| | - Wei Zhang
- 3 Department of Radiation Oncology, Yuhuangding Hospital of Yantai, Shandong province, China
| | - Wei Huang
- 2 Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong province, China
| | - Zhongtang Wang
- 2 Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong province, China
| | - Tao Zhou
- 2 Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong province, China
| | - Haiqun Lin
- 2 Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong province, China
| | - Baosheng Li
- 2 Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong province, China
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A Meta-Analysis of Concurrent Chemoradiotherapy for Advanced Esophageal Cancer. PLoS One 2015; 10:e0128616. [PMID: 26046353 PMCID: PMC4457836 DOI: 10.1371/journal.pone.0128616] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/30/2015] [Indexed: 12/26/2022] Open
Abstract
Background Concurrent chemoradiotherapy is a standard treatment for local advanced esophageal cancer, but the outcomes are controversial. Our goals were to compare the therapeutic effects of concurrent chemoradiotherapy and radiotherapy alone in local advanced esophageal cancer using meta-analysis. Methods MEDLINE, EMBASE and the Cochrane library were searched for studies comparing chemoradiotherapy with radiotherapy alone for advanced esophageal cancer. Only randomized controlled trials were included, and extracted data were analyzed with Review Manager Version 5.2. The pooled relative risks (RR) and their 95% confidence intervals (CI) were calculated for statistical analysis. Results Nine studies were included. Of 1,135 cases, 612 received concurrent chemoradiotherapy and 523 were treated with radiotherapy alone. The overall response rate (complete remission and partial remission) was 93.4% for concurrent chemoradiotherapy and 83.7% for radiotherapy alone (P = 0.05). The RR values of 1-year, 3-year, and 5-year survival rates were 1.14 (95% CI: 1.04 - 1.24, P = 0.006), 1.66 (95% CI: 1.34 - 2.06, P < 0.001), and 2.43 (95% CI: 1.63 - 3.63, P < 0.001), respectively. The RR value of the merged occurrence rate of acute toxic effects was 2.34 (95% CI: 1.90 - 2.90, P <0.001). There was no difference in the incidence of late toxic effects, which had an RR value of 1.21 (95% CI: 0.96 - 1.54, P = 0.11). The RR level of persistence and recurrence was 0.71 (95% CI: 0.62 - 0.81, P <0.001), and for the distant metastasis rate, the RR value was 0.79 (95% CI: 0.61 - 1.02, P = 0.07). Conclusions Concurrent chemoradiotherapy significantly improved overall survival rate, reduced the risk of persistence and recurrence, but had little effect on the primary tumor response, and increased the occurrence of acute toxic effects.
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Yamashita H, Omori M, Takenaka R, Okuma K, Kobayashi R, Ohtomo K, Nakagawa K. Involved-field irradiation concurrently combined with nedaplatin/5-fluorouracil for inoperable esophageal cancer on basis of (18)FDG-PET scans: a phase II study. Radiother Oncol 2014; 113:182-7. [PMID: 25466372 DOI: 10.1016/j.radonc.2014.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/23/2014] [Accepted: 11/03/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE A prospective study was performed on chemoradiotherapy (CRT) for esophageal cancer using involved-field radiation therapy (IFRT) based on 18-fluorodeoxyglucose positron-emission tomography. The goal of this phase II study was to evaluate the efficacy of the IFRT procedure in newly diagnosed esophageal cancer. PATIENTS AND METHODS Eligible patients were adults with newly diagnosed untreated, inoperable esophageal cancer in stages I-IV with lymph node metastases. Patients received nedaplatin 80mg/m(2) per day on day 1, 5-fluorouracil 800mg/m(2) on days 1-4 intravenously repeated every 28days for 2-4 cycles, and combined IFRT. Elective nodal irradiation was not performed. Irradiation was applied only to the primary tumor and positive lymph nodes. RESULTS From September 2009 to July 2012, of the 63 patients enrolled, 58 were evaluable for response. The primary end point of isolated out-of-field loco-regional nodal recurrence was seen in only two patients. The expectant rate was assumed to be less than 5%. The threshold value was set as 10% to calculate the number of registrations. Progression-free and overall survival rates at 36months were 47.7% and 51.1%, respectively. The median progression-free survival was 34.6months, and overall survival was 38.4months. Salvage surgery was tried for 11 patients (17.5%) due to residual or recurrent disease. CONCLUSION The primary end point of the trial was demonstrated, indicating the efficacy of IFRT in the treatment of inoperable esophageal cancer mostly of squamous cell carcinoma.
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Affiliation(s)
| | - Mami Omori
- Department of Radiology, University of Tokyo Hospital, Japan
| | | | - Kae Okuma
- Department of Radiology, University of Tokyo Hospital, Japan
| | - Reiko Kobayashi
- Department of Radiology, University of Tokyo Hospital, Japan
| | - Kuni Ohtomo
- Department of Radiology, University of Tokyo Hospital, Japan
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Yu WW, Zhu ZF, Fu XL, Zhao KL, Mao JF, Wu KL, Yang HJ, Fan M, Zhao S, Welsh J. Simultaneous integrated boost intensity-modulated radiotherapy in esophageal carcinoma: early results of a phase II study. Strahlenther Onkol 2014; 190:979-986. [PMID: 24609941 DOI: 10.1007/s00066-014-0636-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The safety and efficacy of using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with esophageal squamous cell carcinoma were evaluated in a single-institution phase II setting. METHODS AND MATERIALS Between June 2007 and October 2009, 45 patients underwent concurrent chemoradiotherapy (n = 27) or radiotherapy alone (n = 18). Two planning target volumes (PTV) were defined for the SIB: PTVC and PTVG, with prescribed doses of 50.4 Gy to the PTVC (1.8 Gy/fraction) and 63 Gy to the PTVG (2.25 Gy/fraction), both given in 28 fractions. RESULTS At a median follow-up interval of 20.3 months, the 3-year overall survival (OS) and progression-free survival (PFS) rates were 42.2 and 40.7 %, respectively. The median overall survival time was 21 months; locoregional control rates were 83.3 % at 1 year and 67.5 % at 3 years. According to CTCAE (version 3.0) criteria, none of the patients developed grade 4-5 toxicity. The most common grade 2 and 3 radiation-related toxicity was radiation esophagitis, occurring in 64 % of all patients (but only 13 % as grade 3). No patient developed grade > 2 pulmonary complications. CONCLUSION SIB-IMRT is a feasible therapeutic approach for esophageal carcinoma patients and provides encouraging locoregional control with a low toxicity profile. Further investigations should focus on dose escalation and optimization of the combination with systemic therapies.
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MESH Headings
- Adult
- Aged
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/radiotherapy
- Chemoradiotherapy, Adjuvant/adverse effects
- Chemoradiotherapy, Adjuvant/methods
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Dose Fractionation, Radiation
- Esophageal Neoplasms/complications
- Esophageal Neoplasms/diagnosis
- Esophageal Neoplasms/radiotherapy
- Esophagitis/diagnosis
- Esophagitis/etiology
- Esophagitis/prevention & control
- Female
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/prevention & control
- Radiation Injuries/diagnosis
- Radiation Injuries/etiology
- Radiation Injuries/prevention & control
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Risk Factors
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Wei-Wei Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Gupta A, Roy S, Majumdar A, Hazra A, Mallik C. A randomized study to compare sequential chemoradiotherapy with concurrent chemoradiotherapy for unresectable locally advanced esophageal cancer. Indian J Med Paediatr Oncol 2014; 35:54-9. [PMID: 25006285 PMCID: PMC4080664 DOI: 10.4103/0971-5851.133722] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chemotherapy combined with radiotherapy can improve outcome in locally advanced esophageal cancer. AIM This study aimed to compare efficacy and toxicity between concurrent chemoradiotherapy (CCRT) and sequential chemoradiotherapy (SCRT) in unresectable, locally advanced, esophageal squamous cell carcinoma (ESSC). MATERIALS AND METHODS Forty-one patients with unresectable, locally advanced ESCC were randomized into two arms. In the CCRT arm (Arm A), 17 patients received 50.4 Gy at 1.8 Gy per fraction over 5.6 weeks along with concurrent cisplatin (75 mg m(-2) intravenously on day 1 and 5-fluorouracil (1000 mg m(-2) continuous intravenous infusion on days 1-4 starting on the first day of irradiation and given after 28 days. In the SCRT arm (Arm B), 20 patients received two cycles of chemotherapy, using the same schedule, followed by radiotherapy fractionated in a similar manner. The endpoints were tumor response, acute and late toxicities, and disease-free survival. RESULTS With a median follow up of 12.5 months, the complete response rate was 82.4% in Arm A and 35% in Arm B (P = 0.003). Statistically significant differences in frequencies of acute skin toxicity (P = 0.016), gastrointestinal toxicity (P = 0.005) and late radiation pneumonitis (P = 0.002) were found, with greater in the CCRT arm. A modest but non-significant difference was observed in median time to recurrence among complete responders in the two arms (Arm A 13 months and Arm B 15.5 months, P = 0.167) and there was also no significant difference between the Kaplan Meier survival plots (P = 0.641) of disease-free survival. CONCLUSIONS Compared to sequential chemoradiotherapy, concurrent chemoradiotherapy can significantly improve local control rate but with greater risk of adverse reactions.
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Affiliation(s)
- Arunima Gupta
- Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | - Somnath Roy
- Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | - Anup Majumdar
- Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | - Chandrani Mallik
- Department of Radiotherapy, IPGMER & SSKM Hospital, Kolkata, West Bengal, India
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Fu C, Li B, Guo L, Li H, Huang W, Gong H, Sun M, Wang Z, Zhou T, Liu C. Phase II study of concurrent selective lymph node late course accelerated hyper-fractionated radiotherapy and pemetrexed and cisplatin for locally advanced oesophageal squamous cell carcinoma. Br J Radiol 2014; 87:20130656. [PMID: 24666012 DOI: 10.1259/bjr.20130656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine the clinical efficacy and toxicity of pemetrexed combined with low-dose cisplatin (CDDP) concurrent with late-course accelerated hyperfractionated (LCAF) intensity-modulated radiation therapy (IMRT) in patients with inoperable locally advanced oesophageal squamous cell carcinoma (ESCC). METHODS Patients with locally advanced ESCC (less than or equal to 75 years of age, clinical stages IIB-IVA and Karnofsky performance status ≥70) were enrolled into the study. A target group size of 22 was projected based on the estimation that 2-year overall survival (OS) would increase from 20% to 40%. Patients were treated with pemetrexed, low-dose CDDP and LCAF IMRT concurrently. The main objective of the study was for a 2-year OS, and the secondary objectives were progression-free survival (PFS), objective response, locoregional failure rate, and acute and late toxicities. RESULTS 25 patients were recruited from October 2008 to July 2011. The median OS was 21 months, with 2- and 5-year OS rates of 44% and 44%, respectively. The median PFS was 18.2 months. The objective response rate was 96% (24/25), with 11 complete responses and 13 partial responses. The locoregional failure rate was 16%. Grades 4 and 5 acute toxicity rates were 8% and 4%, respectively, while no Grade 3 or greater late toxicity was observed. CONCLUSION The findings of this Phase II study indicated that the therapeutic regimen appears to achieve an excellent response rate and favourable survival for locally advanced ESCC. However, the severe acute side effects should be considered cautiously in further studies. ADVANCES IN KNOWLEDGE To our knowledge, this is the first study that introduced pemetrexed and low-dose CDDP combined with LCAF IMRT to treat locally advanced ESCC. The 5-year OS rate was as high as 44%, which was more favourable than other studies.
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Affiliation(s)
- C Fu
- Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, China
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Main BG, Strong S, McNair AG, Falk SJ, Crosby T, Blazeby JM. Reporting outcomes of definitive radiation-based treatment for esophageal cancer: a review of the literature. Dis Esophagus 2014; 28:156-63. [PMID: 24438540 DOI: 10.1111/dote.12168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Accurate evaluation of radical radiotherapy requires well designed research with valid and appropriate outcomes. This study reviewed standards of outcome reporting and study design in randomized controlled trials (RCTs) of radiation-based therapy for esophageal cancer and made recommendations for future work. Randomized controlled trials reporting outcomes of definitive radiation-based treatment alone or in combination with chemotherapy were systematically identified and summarized. The types, frequency, and definitions of all clinical and patient-reported outcomes (PROs) reported in the methods and results sections of papers were examined. Studies providing a definition for at least one outcome and presenting all outcomes reported in the methods were classified as high quality. From 1425 abstracts, 16 RCTs including 1803 patients were identified. The primary outcome was overall survival in 13 studies, but five different definitions were reported. Outcomes for treatment failure included local, regional, and distant failures, and inconsistent definitions were applied. An observer assessment of dysphagia was reported in seven RCTs but PROs were reported in only one. Only three RCTs were at low risk of bias, with all lacking reports of sequence generation and only a minority reporting allocation concealment. The quality of outcome reporting in RCTs was inconsistent and risked bias. A core outcome set including clinical and PROs is needed to improve reporting of trials of definitive radiation-based treatment for esophageal cancer.
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Affiliation(s)
- B G Main
- School of Social and Community Medicine, University of Bristol, Bristol, UK; University Hospitals Bristol NHS Trust, Bristol, UK
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Définition du volume cible anatomoclinique pour l’irradiation des cancers de l’œsophage. Cancer Radiother 2013; 17:453-60. [DOI: 10.1016/j.canrad.2013.07.145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 07/11/2013] [Indexed: 12/13/2022]
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Ding X, Li H, Wang Z, Huang W, Li B, Zang R, Sun H, Yi Y. A Clinical Study of Shrinking Field Radiation Therapy Based on 18F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2013; 12:251-7. [PMID: 23289475 DOI: 10.7785/tcrt.2012.500310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim is to investigate the feasibility of shrinking field technique after 40 Gy for stage III non-small cell lung cancer (NSCLC) during radiation therapy. Eighty-seven consecutive patients treated with intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were enrolled in this study. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scanning was performed prior to treatment and repeated after 40 Gy, and the delineation of target volume was based on fused images of PET and CT. After 40 Gy of conventional fractionated radiotherapy to the initial planning target volume (PTV), a boost of 19.6–39.2 Gy was delivered to the shrunken PTV through late course accelerated hyperfractionated radiotherapy, and the median total dose was 66.0 Gy (range, 59.6–79.2 Gy). Gross tumor volume (GTV) and PTV regressions were recorded, and prescription doses with or without shrinking field were calculated. Local recurrence patterns were investigated through follow-up. The tumor volumes regressed in 84 (96.6%) patients and increased in 3 (3.4%) patients after 40 Gy. The mean GTV and PTV reduction was 38% (range, −13–95%) and 30% (range, −5–95%). Mean total prescription dose escalated from 62.0 Gy to 68.5 Gy through shrinking field technique. The median follow-up was 17 months, ranging from 5 to 46 months, and the 1- and 2-year overall survival rates in our study were 74.7% and 34.6%. The response rate was 79.5%, and radiation toxicity was acceptable. Tumor progression occurred in 67.8% (59/87) patients. Numbers of patients who had outfield, infield and both infield and outfield recurrences were 3 (3.4%), 26 (29.5%), and 3 (3.4%), respectively. In conclusion, significant tumor regression was observed after 40 Gy, and radiation dose escalated after shrinking field with acceptable toxicity and outfield relapse. Shrinking field radiotherapy based on 18F-FDG PET/CT after 40 Gy was safe and feasible for stage III NSCLC.
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Affiliation(s)
- Xiuping Ding
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Hongsheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Rukun Zang
- Department of Radiation Oncology, Cancer Hospital, Tianjin Medical University, Tianjin, P.R. China
- Department of Radiation Oncology, Yantai Yuhuangding Hospital, Yantai, P.R. China
| | - Hongfu Sun
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
| | - Yan Yi
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan, P.R. China
- Shandong's Key Laboratory of Radiation Oncology, Jinan, P.R. China
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Elective lymph node irradiation late course accelerated hyper-fractionated radiotherapy plus concurrent cisplatin-based chemotherapy for esophageal squamous cell carcinoma: a phase II study. Radiat Oncol 2013; 8:108. [PMID: 23638721 PMCID: PMC3653710 DOI: 10.1186/1748-717x-8-108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 04/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this phase II study, we evaluated the efficacy, toxicity, and patterns of failure of elective lymph node irradiation (ENI) late course accelerated hyper-fractionated radiotherapy (LCAHRT) concurrently with cisplatin-based chemotherapy (CHT) for esophageal squamous cell carcinoma (ESCC). METHODS Patients with clinical stage II-IVa (T1-4N0-1M0 or M1a) ESCC were enrolled between 2004 and 2011. Radiation therapy (RT) comprised two courses: The first course of radiation covered the primary and metastatic regional tumors and high risk lymph nodal regions, given at 2 Gy per fraction for a dose of 40 Gy. In the second course, LCAHRT was delivered to the boost volume twice a day for an additional 19.6 Gy in 7 treatment days, using 1.4 Gy per fraction. Two cycles of CHT were given at the beginning of RT. RESULTS The median age and Karnofsky performance status were 63 years and 80, respectively. The American Joint Committee on Cancer stage was II in 14 (20.6%) patients, III in 32 (47.1%), and IVa in 22 (32.3%). With a median follow-up of 18.5 months, the overall survival at 1-, 3-, 5-year were 75.5%, 46.5%, 22.7% for whole group patients, versus 78.6%, 49.4%, 39.9% for patients with stage II-III. The patterns of first failure from local recurrence, regional failure, and distant metastasis were seen in 20.6%, 17.6%, and 19.1%, respectively. The most frequent acute high-grade (≥ 3) toxicities were esophagitis and leucopenia, occurred in 26.4% and 32.4%. CONCLUSIONS ENI LCAHRT concurrently with CHT was appeared to be an effective regimen for ESCC patient with a favorable and tolerated profile. Further observation with longer time and randomized phase III trial is currently underway. TRIAL REGISTRATION ChiCTR-TRC-09000568.
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Meng MB, Jiang C, Tian LJ, Liu CL, Zhuang HQ, Chen ZJ, Song YC, Wang J, Pang QS, Zhao LJ, Yuan ZY, Wang P. Late course accelerated hyperfractionation radiotherapy for locally advanced esophageal squamous cell carcinoma. Thorac Cancer 2013; 4:174-185. [PMID: 28920199 DOI: 10.1111/j.1759-7714.2012.00166.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/11/2012] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Late course accelerated hyperfractionation radiotherapy (LCAHR) is used as a standard treatment option for locally advanced esophageal squamous cell carcinoma (LAESCC) in China, but concerns remain regarding its efficacy and safety. The purpose of this paper was to evaluate the efficacy and safety of LCAHR. The comparisons examined were as follows: LCAHR versus conventional fractionation radiotherapy (CFR) and LCAHR plus chemotherapy (CT) versus LCAHR alone. METHODS We searched the Cochrane Library, MEDLINE, EMBASE, CENTRAL, CBMdisc, and CNKI, as well as employing manual searches. The primary end points were survival and local control. The second end point was toxicities. RESULTS Based on search criteria, we found 29 trials involving 3187 patients. Our results showed that LCAHR, compared with CFR, improved the survival and local control, and was, thus, more therapeutically beneficial. Further analysis revealed that LCAHR plus CT proved to be better for patients' survival and local control compared to LCAHR alone. Acute toxicities were increased rather than late toxicities. CONCLUSIONS There was a significant survival and local control benefit of LCAHR over CFR, as well as LCAHR plus CT over LCAHR alone. Considering the strength of the evidence, the results of this study indicate that this regimen would be a new promising modality worth further investigation.
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Affiliation(s)
- Mao-Bin Meng
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Cyberknife Center, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Chao Jiang
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Li-Jun Tian
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Chun-Lei Liu
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Hong-Qing Zhuang
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Cyberknife Center, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Zhong-Jie Chen
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Yong-Chun Song
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Cyberknife Center, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Jun Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Qing-Song Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Lu-Jun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Zhi-Yong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Cyberknife Center, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China.,Cyberknife Center, Tianjin Medical University Cancer Hospital & Institute, Tianjin, China
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Cooper SL, Russo JK, Chin S. Definitive chemoradiotherapy for esophageal carcinoma. Surg Clin North Am 2012; 92:1213-48. [PMID: 23026279 DOI: 10.1016/j.suc.2012.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Radiation therapy plays an important role in the treatment of esophageal cancer. Radiation therapy may be combined with chemotherapy, used as a component of induction therapy, used in the adjuvant setting, or used for palliation of advanced disease. Chemotherapy is also occasionally used as a solitary treatment modality for patients with esophageal cancer. Current treatment protocols include multiple agents, and agents directed against specific molecular targets have been investigated in clinical trials. This article discusses future directions related to the selection of radiation treatment protocols, novel targeted chemotherapeutic agents, and the selection of patients for surgery.
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Affiliation(s)
- S Lewis Cooper
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
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Liu M, Shi X, Guo X, Yao W, Liu Y, Zhao K, Jiang GL. Long-term outcome of irradiation with or without chemotherapy for esophageal squamous cell carcinoma: a final report on a prospective trial. Radiat Oncol 2012; 7:142. [PMID: 22913676 PMCID: PMC3494533 DOI: 10.1186/1748-717x-7-142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 08/09/2012] [Indexed: 01/16/2023] Open
Abstract
Purpose To investigate the long-term outcome of esophageal squamous cell carcinoma (SCC) treated by irradiation with or without concurrent chemotherapy. Methods and materials A prospective clinical trial was carried out from 1998 to 2000. One hundred and eleven patients were randomly enrolled to receive either late course accelerated hyperfractionated irradiation (LCAF) or LCAF with concurrent chemotherapy (LCAF + CT). For LCAF, 41.4 Gy in 23 fractions was first delivered at five fractions per week, followed by 27 Gy in 18 fractions at two 1.5 Gy fractions a day. Concurrent chemotherapy of cis-platinum and 5-fluorouracil was administered for four cycles. Overall survival (OS), locoregional recurrence and distant metastasis were observed. Late toxicity was scored by RTOG criteria, and quality of life (QOL) was also evaluated. Results The median follow-up time was 24 months for all patients and 138 months for 17 living patients. Median survival time was 25 months and 32 months in LCAF and LCAF + CT (p = 0.653), respectively. For an entire group of patients, overall survivals were 34%, 27% and 22%; locoregional recurrence rates were 30%, 36% and 41%; and distant metastasis rates were 26%, 28% and 29% at 5-yr, 8-yr and 10-yr, respectively. Incidences of ≥ Grade 3 late toxicity were 29% at 10-yr. There were no statistically significant differences between LCAF and LCAF + CT with respect to the parameters mentioned above. Cumulative incidence of late toxicities of ≥ Grade 3 increased sharply after the attained age of 70 years. Eighty-eight percent of patients lived with good KPS (≥ 90) and 94% could eat regular or soft diet. Conclusion The long-term outcome of esophageal SCC patients who received LCAF or LCAF + CT was good. The locoregional and distant failures occurred more often in the first three years after treatment, but could continuously occur up to 10 years. The late toxicity was acceptable. Late toxicities ≥ Grade 3 were more likely to occur in elderly patients. QOL was good in living patients.
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Affiliation(s)
- Mina Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Linear Correlation Between Patient Survival and Decreased Percentage of Tumor [18F]Fluorodeoxyglucose Uptake for Late-Course Accelerated Hyperfractionated Radiotherapy for Esophageal Cancer. Int J Radiat Oncol Biol Phys 2012; 82:1535-40. [DOI: 10.1016/j.ijrobp.2011.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 04/28/2011] [Accepted: 05/05/2011] [Indexed: 12/22/2022]
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Wang D, Yang Y, Zhu J, Li B, Chen J, Yin Y. 3D-conformal RT, fixed-field IMRT and RapidArc, which one is better for esophageal carcinoma treated with elective nodal irradiation. Technol Cancer Res Treat 2012; 10:487-94. [PMID: 21895033 DOI: 10.7785/tcrt.2012.500225] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The purpose of this study is to compare the characteristics of 3D-conformal radiotherapy (3D-CRT), fixed-field intensity-modulated radiotherapy (IMRT) and RapidArc for esophageal squamous cell carcinoma (ESCC) treated with elective nodal irradiation (ENI). CT datasets of 20 patients with ESCC were included and plans for single and double arcs of RapidArc (RA1 and RA2), 7-field IMRT and 3D-CRT were created and optimized for each patient. The goal was to deliver 59.6 Gy to ≥95% of the planning target volume (40 Gy to electively irradiated lymph nodal regions) while meeting the same normal-tissue dose constraints. The plans were compared based on dosimetric characteristics of target and organs at risk (OARs), monitor units (MUs), and appraised beam-on time. Both RA2 and IMRT resulted in similar target coverage (V95%, 97.84±1.50% for RA2 versus 96.96±1.15% for IMRT), homogeneity index (HI, 0.11±0.02 for RA2 versus 0.10±0.01 for IMRT) and conformity index (CI, 0.81±0.03 for RA2 versus 0.79±0.04 for IMRT), which displayed slightly better than single arc (V95%=94.55±1.50%, HI=0.12±0.02, CI=0.80±0.02) and much better than 3D-CRT (V95%=91.17±2.89%, HI=0.15±0.03, CI=0.60±0.07). The total lung V20, V30 was reduced approximately from 31%, 16% (3D-CRT) to 22%, 13% (IMRT) and 20%, 12% (RA2); the heart V30, V40 from 29%, 21% (3D-CRT) to 28%, 20% (IMRT) and 27%, 18% (RA2). The maximum dose to the spinal cord was 44.26±2.60 Gy for 3D-CRT, 42.47±2.40 Gy for IMRT, and 42.79±1.81 Gy for RA2. The number of MUs per fraction reduced from 990±165 (IMRT) to 503±70 (3D-CRT) and 502±79 (RA2). Appraised beam-on time of RapidArc was 1.2-2.4 min, which was lower than IMRT with 5.4 min by average. RapidArc, especially for double arcs plan could provide slight improvements in OARs sparing and lower MUs without compromised target qualities compared with IMRT, which was much better than 3D-CRT for ESCC treated with ENI.
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Affiliation(s)
- D Wang
- Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, PR China
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Mizumoto M, Sugahara S, Okumura T, Hashimoto T, Oshiro Y, Fukumitsu N, Nakahara A, Terashima H, Tsuboi K, Sakurai H. Hyperfractionated Concomitant Boost Proton Beam Therapy for Esophageal Carcinoma. Int J Radiat Oncol Biol Phys 2011; 81:e601-6. [DOI: 10.1016/j.ijrobp.2011.02.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 02/07/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
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Ma JB, Song YP, Yu JM, Zhou W, Cheng EC, Zhang XQ, Kong L. Feasibility of involved-field conformal radiotherapy for cervical and upper-thoracic esophageal cancer. ACTA ACUST UNITED AC 2011; 34:599-604. [PMID: 22104156 DOI: 10.1159/000334194] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of involved-field irradiation (IFI) for the treatment of cervical and upper-thoracic esophageal cancer with concurrent chemoradiation. PATIENTS AND METHODS 102 eligible patients with cervical or upper-thoracic esophageal cancer were treated with concurrent chemoradiation and randomized to either an IFI or elective nodal irradiation (ENI) group. RESULTS Adverse events included infection (27.4 vs. 64.7%) and nausea (25.4 vs. 54.9%), with a statistically significant difference between the IFI and the ENI group (p = 0.008 and 0.028, respectively). No difference was seen for late radiation reaction. The cumulative incidence of local/regional failure (13.7 vs. 17.6%) and regional lymph failure (7.8 vs. 9.8%) showed no statistically significant difference between the IFI versus the ENI group (p = 0.837 and 0.837, respectively). A nodal out-field relapse rate of only 2% was seen in the IFI group. 3-year survival rates for the ENI and IFI group were 41.3 and 32.0%, respectively (p = 0.58), and 3-year local control rates were 85.7 and 80.1%, respectively (p = 0.34). CONCLUSION IFI was acceptable for cervical and upper-thoracic esophageal cancer with a decrease in acute toxicities and no increase in lymph node failure.
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Affiliation(s)
- Jin-Bo Ma
- Department of Oncology, Shandong University, School of Medicine, PR China
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Yu J, Liu F, Sun Z, Sun M, Sun S. The enhancement of radiosensitivity in human esophageal carcinoma cells by thalidomide and its potential mechanism. Cancer Biother Radiopharm 2011; 26:219-27. [PMID: 21539454 DOI: 10.1089/cbr.2010.0897] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
To investigate the effects of thalidomide on the radiosensitivity of human esophageal cancer cells (TE1 cells) and the potential mechanism underlying these effects. The effects of thalidomide on proliferation of TE1 cells were determined by Methyl thiazolyl tetrazolium assay. The multitarget click model was used to delineate the survival curve using a colony-forming assay, and the radiosensitivity was determined after TE1 cells were treated by thalidomide and/or X-ray radiation. The cell cycle was detected using flow cytometry. Our results are as follows: thalidomide alone suppressed the proliferation of TE1 cells in a dose- and time-dependent manner. The suppressive effects were enhanced by prolonged duration or elevated concentration of thalidomide. However, thalidomide did not affect the cell cycle of TE1 cells. The expression of vascular endothelial growth factor (VEGF) mRNA and protein was suppressed after treatment with thalidomide alone in a dose-dependent manner. Synergistic suppressive effects on VEGF expression were observed after administration of thalidomide and X-ray exposure. In conclusion, thalidomide was able to enhance the radiosensitivity of TE1 cells in vitro, which could be closely related to its suppressive effects on the expression of VEGF in TE1 cells, but had no obvious effects on the cell cycle.
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Affiliation(s)
- Jingping Yu
- College of Radiological Medicine and Public Health, Soochow University, Suzhou, China
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Nguyen NP, Krafft SP, Vinh-Hung V, Vos P, Almeida F, Jang S, Ceizyk M, Desai A, Davis R, Hamilton R, Modarresifar H, Abraham D, Smith-Raymond L. Feasibility of tomotherapy to reduce normal lung and cardiac toxicity for distal esophageal cancer compared to three-dimensional radiotherapy. Radiother Oncol 2011; 101:438-42. [PMID: 21908064 DOI: 10.1016/j.radonc.2011.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 06/16/2011] [Accepted: 07/24/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the effectiveness of tomotherapy and three-dimensional (3D) conformal radiotherapy to spare normal critical structures (spinal cord, lungs, and ventricles) from excessive radiation in patients with distal esophageal cancers. MATERIALS AND METHODS A retrospective dosimetric study of nine patients who had advanced gastro-esophageal (GE) junction cancer (7) or thoracic esophageal cancer (2) extending into the distal esophagus. Two plans were created for each of the patients. A three-dimensional plan was constructed with either three (anteroposterior, right posterior oblique, and left posterior oblique) or four (right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique) fields. The second plan was for tomotherapy. Doses were 45 Gy to the PTV with an integrated boost of 5 Gy for tomotherapy. RESULTS Mean lung dose was respectively 7.4 and 11.8 Gy (p=0.004) for tomotherapy and 3D plans. Corresponding values were 12.4 and 18.3 Gy (p=0.006) for cardiac ventricles. Maximum spinal cord dose was respectively 31.3 and 37.4 Gy (p < 0.007) for tomotherapy and 3D plans. Homogeneity index was two for both groups. CONCLUSIONS Compared to 3D conformal radiotherapy, tomotherapy decreased significantly the amount of normal tissue irradiated and may reduce treatment toxicity for possible dose escalation in future prospective studies.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, AZ 85724-5081, USA.
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Li BS, Gong HY, Huang W, Yi Y, Zhang ZC, Li HS, Wang ZT, Yu JM. Phase I study of concurrent selective lymph node late course accelerated hyper-fractionated radiotherapy and pemetrexed, cisplatin for locally advanced esophageal squamous cell carcinoma. Dis Esophagus 2011; 24:251-7. [PMID: 21073623 DOI: 10.1111/j.1442-2050.2010.01130.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The optimized concurrent chemoradiotherapy has not been established for patients with advanced esophageal squamous cell carcinoma (SCC). The aim of the present study was to evaluate the safety and efficacy of concurrent chemotherapy and selective lymph node (SLN) late course accelerated hyperfractionated (LCAF) intensity modulated radiotherapy (IMRT) for the patients with thoracic SCC. Twelve patients with T3-4N0-1M0-1a thoracic esophageal SCC were included. The total dose of SLN LCAF IMRT was 59.6 Gy/34 fractions in 5.4 weeks. The concurrent chemotherapy protocol was as following: cisplatin 10 mg/m(2) on days 1-5 and 22-26, pemetrexed in escalating doses, from the base level of 500 mg/m(2) once every 21 days. The primary objectives were to determine the maximum tolerated dose (MTD), recommended dose (RD), and dose limiting toxicities (DLTs). Secondary end point included determination of preliminary radiographic response rates. As a result, three patients were enrolled in dose level 1 with pemetrexed 500 mg/m(2) and nine patients in dose level 0 with 400 mg/m(2) , respectively. At dose level 1, DLTs occurred in two of three patients. However, only two of nine patients in Level 0 developed DLTs. The complete response and partial response were observed in eight and four patients, respectively. Furthermore, no patient experienced cancer progression with a median follow-up of 9 months. In conclusion, the concurrent SLN LCAF IMRT and chemotherapy is feasible. The MTD of pemetrexed in this regimen was 500 mg/m(2) and RD was 400 mg/m(2) . Although toxicities were common, the protocol was safe, well tolerated, and achieved an encouraging outcome.
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Affiliation(s)
- Bao-Sheng Li
- Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, Shandong Province, China.
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Clinical Results of Proton-Beam Therapy for Locoregionally Advanced Esophageal Cancer. Strahlenther Onkol 2010; 186:482-8. [DOI: 10.1007/s00066-010-2079-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 03/25/2010] [Indexed: 12/01/2022]
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Yue J, Chen L, Cabrera AR, Sun X, Zhao S, Zheng F, Han A, Zheng J, Teng X, Ma L, Ma Y, Han D, Zhao X, Mu D, Yu J, Li Y. Measuring Tumor Cell Proliferation with 18F-FLT PET During Radiotherapy of Esophageal Squamous Cell Carcinoma: A Pilot Clinical Study. J Nucl Med 2010; 51:528-34. [DOI: 10.2967/jnumed.109.072124] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zhao KL, Ma JB, Liu G, Wu KL, Shi XH, Jiang GL. Three-dimensional conformal radiation therapy for esophageal squamous cell carcinoma: is elective nodal irradiation necessary? Int J Radiat Oncol Biol Phys 2010; 76:446-451. [PMID: 20004527 DOI: 10.1016/j.ijrobp.2009.02.078] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 02/05/2009] [Accepted: 02/07/2009] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the local control, survival, and toxicity associated with three-dimensional conformal radiotherapy (3D-CRT) for squamous cell carcinoma (SCC) of the esophagus, to determine the appropriate target volumes, and to determine whether elective nodal irradiation is necessary in these patients. METHODS AND MATERIALS A prospective study of 3D-CRT was undertaken in patients with esophageal SCC without distant metastases. Patients received 68.4 Gy in 41 fractions over 44 days using late-course accelerated hyperfractionated 3D-CRT. Only the primary tumor and positive lymph nodes were irradiated. Isolated out-of-field regional nodal recurrence was defined as a recurrence in an initially uninvolved regional lymph node. RESULTS All 53 patients who made up the study population tolerated the irradiation well. No acute or late Grade 4 or 5 toxicity was observed. The median survival time was 30 months (95% confidence interval, 17.7-41.8). The overall survival rate at 1, 2, and 3 years was 77%, 56%, and 41%, respectively. The local control rate at 1, 2, and 3 years was 83%, 74%, and 62%, respectively. Thirty-nine of the 53 patients (74%) showed treatment failure. Seventeen of the 39 (44%) developed an in-field recurrence, 18 (46%) distant metastasis with or without regional failure, and 3 (8%) an isolated out-of-field nodal recurrence only. One patient died of disease in an unknown location. CONCLUSIONS In patients treated with 3D-CRT for esophageal SCC, the omission of elective nodal irradiation was not associated with a significant amount of failure in lymph node regions not included in the planning target volume. Local failure and distant metastases remained the predominant problems.
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Affiliation(s)
- Kuai-le Zhao
- Department of Oncology, Fudan University Cancer Hospital, Shanghai, PR China
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Abstract
The treatment of esophageal cancer with curative intent remains highly controversial, with advocates of surgery alone, chemoradiotherapy alone, surgery with adjuvant therapy (including neoadjuvant and postoperative), and trimodality therapy each contributing prospective randomized controlled trials (PRCTs) to the body of scientific publications between 2000 and 2008. Any improvements in survival have been small in absolute percentage terms, and as such PRCTs published over the last decade have met the same primary obstacle encountered by the studies from the two prior decades, namely lack of power to detect small differences in outcome. Variations in staging methods, surgical technique, radiotherapy technique, and chemotherapy regime have in turn been the subject of PRCTs over the last nine years. In many cases primary end points have not been survival but rather rates of complication or response. As well as giving an overview of PRCTs, this article collates the level Ia evidence published to date.
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Affiliation(s)
- Stephen A Barnett
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Li BS, Zhou T, Wang ZT, Li HS, Sun HF, Zhang ZC, Lin HQ, Wei YM, Gong HY, Huang W, Yi Y, Wang LY. Phase I study of concurrent selective lymph node late course accelerated hyper-fractionated radiotherapy and Capecitabine, Cisplatin for locally advanced esophageal squamous cell carcinoma. Radiother Oncol 2009; 93:458-61. [PMID: 19733411 DOI: 10.1016/j.radonc.2009.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 08/01/2009] [Accepted: 08/11/2009] [Indexed: 12/27/2022]
Abstract
Twelve patients with locally advanced esophageal squamous cell carcinoma were enrolled to evaluate the safety and efficacy of concurrent chemo-radiotherapy. Dose-limiting toxicity was mainly observed at Capecitabine 1500 mg. The maximum-tolerated dose/recommended dose of Capecitabine was 1000 mg. The Kaplan-Meier estimated overall l-year survival rate was 100%.
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Affiliation(s)
- Bao-sheng Li
- Sixth Department of Radiation Oncology, Shandong Cancer Hospital, Shandong Province, PR China
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Ogawa R, Ishiguro H, Kuwabara Y, Kimura M, Mitsui A, Mori Y, Mori R, Tomoda K, Katada T, Harada K, Fujii Y. Identification of candidate genes involved in the radiosensitivity of esophageal cancer cells by microarray analysis. Dis Esophagus 2008; 21:288-97. [PMID: 18477249 DOI: 10.1111/j.1442-2050.2007.00759.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Radiotherapy plays a key role in the control of tumor growth in esophageal cancer patients. To identify the patients who will benefit most from radiation therapy, it is important to know the genes that are involved in the radiosensitivity of esophageal cancer cells. Hence, we examined the global gene expression in radiosensitive and radioresistant esophageal squamous cell carcinoma cell lines. Radiosensitivities of 13 esophageal cancer cell lines were measured. RNA was extracted from each esophageal cancer cell line and a normal esophageal epithelial cell line, and the global gene expression profiles were analyzed using a 34 594-spot oligonucleotide microarray. In the clonogenic assay, one cell line (TE-11) was identified to be highly sensitive to radiation, while the other cell lines were found to be relatively radioresistant. We identified 71 candidate genes that were differentially expressed in TE-11 by microarray analysis. The up-regulated genes included CABPR, FABP5, DSC2, GPX2, NME, CBR3, DOCK8, and ABCC5, while the down-regulated genes included RPA1, LDOC1, NDN, and SKP1A. Our investigation provided comprehensive information on genes related to radiosensitivity of esophageal cancer cells; this information can serve as a basis for further functional studies.
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Affiliation(s)
- R Ogawa
- Nagoya City University Graduate School of Medical Sciences, Oncology, Immunology and Surgery, Nagoya, Japan
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Sun SP, Jin YN, Yang HP, Wei Y, Dong Z. Serum transforming growth factor-β1 level reflects disease status in patients with esophageal carcinoma after radiotherapy. World J Gastroenterol 2007; 13:5267-72. [PMID: 17876899 PMCID: PMC4171310 DOI: 10.3748/wjg.v13.i39.5267] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the relationship between changes in serum transforming growth factor β1 (TGFβ1) level and curative effect of radiotherapy (RT) in patients with esophageal carcinoma.
METHODS: Ninety patients with histologically confirmed esophageal carcinoma were enrolled. Serum samples for TGFβ1 analysis were obtained before and at the end of RT. An enzyme-linked immunosorbent assay was used to measure serum TGFβ1 level. Multivariate analysis was performed to investigate the relationship between disease status and changes in serum TGFβ1 level.
RESULTS: Serum TGFβ1 level in patients with esophageal carcinoma before RT was significantly higher than that in healthy controls (P < 0.001). At the end of RT, serum TGFβ1 level was decreased in 67.82% (59/87) of the patients. The overall survival rate at 1, 3 and 5 years was 48.28% (42/87), 19.54% (17/87) and 12.64% (11/87), respectively. Main causes of death were local failure and regional lymph node metastasis. In patients whose serum TGFβ1 level decreased after RT, the survival rate at 1, 3 and 5 years was 61.02% (36/59), 28.81% (17/59) and 18.64% (11/59), respectively. The survival rate at 1 year was 17.86% (5/28) in patients whose serum TGFβ1 level increased after RT, and all died within 18 mo (P < 0.01).
CONCLUSION: Serum TGFβ1 level may be a useful marker for monitoring disease status after RT in patients with esophageal carcinoma.
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Affiliation(s)
- Su-Ping Sun
- Department of Radiation Oncology, Changzhou Second Hospital-Affiliated Hospital of Nanjing Medical University, Changzhou, 213003, Jiangsu Province, China.
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