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Rao V, Singh S, Zade B. Advances in radiotherapy in the treatment of esophageal cancer. World J Clin Oncol 2025; 16:102872. [PMID: 40130058 PMCID: PMC11866087 DOI: 10.5306/wjco.v16.i3.102872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 12/06/2024] [Accepted: 12/27/2024] [Indexed: 01/21/2025] Open
Abstract
Recent advancements in radiotherapy for esophageal cancer have significantly improved treatment outcomes and patient quality of life. Traditional radiotherapy techniques have been enhanced by the integration of advanced imaging and precision targeting technologies, such as intensity-modulated radiotherapy and proton therapy, which allow for more accurate tumor targeting while minimizing damage to surrounding healthy tissues. Additionally, combining radiotherapy with immunotherapy has shown promising results, leveraging the body's immune response to enhance the effectiveness of cancer treatment. Studies have also highlighted the benefits of neoadjuvant chemoradiation followed by surgical resection, which has been associated with improved overall survival rates compared to radiotherapy alone. These innovations are paving the way for more effective and personalized treatment strategies, offering new hope for patients with esophageal cancer.
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Affiliation(s)
- Vrushab Rao
- Department of Cyberknife Radiosurgery and Radiation Oncology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | - Soumya Singh
- Department of Cyberknife Radiosurgery and Radiation Oncology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | - Bhooshan Zade
- Department of Cyberknife Radiosurgery and Radiation Oncology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
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Abana CO, Carriere PP, Damen PJ, van Rossum PSN, Yoder AK, Bravo PL, Wei X, Pollard-Larkin JM, Nitsch PL, Murphy MB, Hofstetter WL, Liao Z, Lin SH. Comparative Outcomes and Toxicity in Patients With Esophageal Cancer After Trimodality Therapy With Step-and-Shoot Intensity-Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy: The MD Anderson Experience. Clin Oncol (R Coll Radiol) 2025; 38:103668. [PMID: 39706143 DOI: 10.1016/j.clon.2024.103668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/15/2024] [Accepted: 10/24/2024] [Indexed: 12/23/2024]
Abstract
AIMS To evaluate outcomes and toxicity after intensity-modulated radiation therapy given as step-and-shoot (SS) or volumetric modulated arc therapy (VMAT) for patients with locally advanced esophageal cancer treated with trimodality therapy (i.e. neoadjuvant concurrent chemoradiation therapy followed by surgery). MATERIALS AND METHODS Patients consecutively treated with trimodality therapy including IMRT in 2001-2022 (n = 449) were retrospectively reviewed, and 106 pairs of propensity-matched SS and VMAT patients were identified. Survival, recurrence, surgery-related prognostic factors, and chemoradiation-related toxicities were evaluated between groups. RESULTS Baseline characteristics were balanced between both groups except for body mass index, history of other cancer, clinical disease stage, and use of induction chemotherapy. Median follow-up time was 40 months. Relative to SS, VMAT led to higher 3-year overall survival (OS; P = 0.028, hazard ratio [HR] 0.645, 95% confidence interval [CI] 0.436-0.954) but not progression-free, locoregional recurrence-free, or distant metastasis-free survival. No predictor of excellent OS by SS versus VMAT was identified in multivariable analyses. However, VMAT was associated with reduced odds of postoperative cardiac complications (P < 0.001, odds ratio [OR] 0.296, 95% CI 0.148-0.591), pulmonary complications (P = 0.048, OR 0.539, 95% CI 0.292-0.994), pathologic partial response or worse (≥10% viable cells; P = 0.003, OR 0.418, 95% CI 0.235-0.743), and positive/close margins (P = 0.023, OR 0.346, 95% CI 0.138-0.867) relative to SS. VMAT was also associated with reduced rates of chemoradiation therapy-related weight loss (33.0% versus 79.2%, P < 0.001), fatigue (40.6% versus 68.9%, P < 0.001), nausea (31.1% versus 58.5%, P < 0.001) and cardiac toxicity (0% versus 6.6%, P = 0.007) than SS. CONCLUSION Based on this single institution, retrospective study with a 40-month median follow-up, VMAT utilization in trimodality treatment for locally advanced esophageal cancer appears to be associated with improved OS and rates of concurrent chemoradiation therapy-related toxicity and reduced initial 12-month postoperative complications relative to SS IMRT. Multi-institutional prospective trials addressing the limitations of this study and with longer follow-ups are warranted to validate these findings.
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Affiliation(s)
- C O Abana
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - P P Carriere
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P J Damen
- Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P S N van Rossum
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - A K Yoder
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P L Bravo
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - X Wei
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J M Pollard-Larkin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - P L Nitsch
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M B Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - W L Hofstetter
- Department of Thoracic & Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Z Liao
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S H Lin
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Mishra V, Yadav R, Chaudhary S, Pandey L, Pandey A. Retrospective Analysis of Dosimetric Comparison Between Intensity-Modulated Radiation Therapy and Volumetric-Modulated Arc Therapy in Patients With Esophageal Cancer. Cureus 2025; 17:e76981. [PMID: 39912037 PMCID: PMC11794999 DOI: 10.7759/cureus.76981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2025] [Indexed: 02/07/2025] Open
Abstract
Introduction Esophageal cancer is a significant global health concern, with high incidence and mortality rates, particularly in India, where it ranks among the top causes of cancer-related deaths. Radiotherapy plays a critical role in the treatment of advanced-stage esophageal cancer. This study aims to compare the dosimetric outcomes of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) to evaluate their efficacy and safety in managing mid-esophageal carcinoma. Materials and methods A retrospective study was carried out on thirty patients with middle-third esophageal cancer who received treatment at Rohilkhand Medical College and Hospital, Bareilly, India. The patients, aged between 50 and 70 years (mean age of 66.5 years), were in stages II to III of cancer according to the American Joint Committee on Cancer (AJCC) 2018 guidelines. All patients had histologically confirmed cases of moderately differentiated squamous cell carcinoma. The treatment procedure included immobilization using a thoracic mold, CT simulation with intravenous and oral contrast, and contouring of the gross tumor volume (GTV), clinical target volume (CTV), planning target volume (PTV), and organs at risk (OARs) following the Radiation Therapy Oncology Group (RTOG) 0436 protocol. VMAT planning was done using the Varian Eclipse™ Treatment Planning System, while IMRT planning employed a seven-field non-coplanar beam setup. Comparative virtual IMRT plans were generated for these patients. Both VMAT and IMRT plans were evaluated based on dosimetric parameters for the PTV and OARs. Results Both VMAT and IMRT achieved sufficient PTV coverage, with no statistically significant differences in dosimetric parameters (dose to 99 % volume of PTV, dose to 95 %volume of PTV, maximum dose to PTV, minimum dose to PTV). VMAT demonstrated reduced lung and heart doses compared to IMRT; however, the observed differences were not statistically significant. There was a reduction in lung dose with VMAT when evaluating the dose-volume constraints: volume receiving 15 Gy dose (V15) by 11%, volume receiving 20 Gy dose (V20) by 20%, and volume receiving 25 Gy dose (V25) by 41%, though these differences were not statistically significant. The mean maximum spinal cord dose was significantly lower with VMAT (19.69 Gy) compared to IMRT (30.80 Gy, p=0.01). Heart dosimetry showed slight improvements with VMAT, particularly in volume receiving 30 Gy dose (V30), volume receiving 40 Gy dose (V40), and mean heart dose, though these differences were not statistically significant. Conclusion Both VMAT and IMRT provided similar PTV coverage. VMAT showed a reduction in spinal cord dose, which was statistically significant, and a trend toward lower lung and heart doses, though these differences were not statistically significant. VMAT appears to be an effective option for treating mid-esophageal carcinoma while reducing exposure to critical organs.
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Affiliation(s)
- Vishwadeep Mishra
- Radiation Oncology, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Rashmi Yadav
- Radiation Oncology, Hind Institute of Medical Sciences, Barabanki, IND
| | | | - Laxman Pandey
- Radiation Oncology, Rohilkhand Medical College and Hospital, Bareilly, IND
| | - Archana Pandey
- Radiation Oncology, Rohilkhand Medical College and Hospital, Bareilly, IND
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Shao Y, Chen H, Wang H, Duan Y, Feng A, Huang Y, Gu H, Kong Q, Xu Z. Investigation of Predictors to Achieve Acceptable Lung Dose in T-Shaped Upper and Middle Esophageal Cancer With IMRT and VMAT. Front Oncol 2021; 11:735062. [PMID: 34692508 PMCID: PMC8529030 DOI: 10.3389/fonc.2021.735062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/09/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study is to investigate whether there are predictors and cutoff points that can predict the acceptable lung dose using intensity-modulated radiation therapy (IMRT) and volume-modulated arc therapy (VMAT) in radiotherapy for upper ang middle esophageal cancer. Material and Methods Eighty-two patients with T-shaped upper-middle esophageal cancer (UMEC) were enrolled in this retrospective study. Jaw-tracking IMRT plan (JT-IMRT), full-arc VMAT plan (F-VMAT), and pactial-arc VMAT plan (P-VMAT) were generated for each patient. Dosimetric parameters such as MLD and V20 of total lung were compared among the three plannings. Ten factors such as PCTVinferior length and PCTVinferior length/total lung length were calculated to find the predictors and cutoff points of the predictors. All patients were divided into two groups according to the cutoff points, and the dosimetric differences between the two groups of the three plans were compared. ANOVA, receiver operating characteristic (ROC) analysis, and Mann–Whitney U-test were performed for comparisons between datasets. A p <0.05 was considered statistically significant. Result The quality of the targets of the three plannings was comparable. The total lung dose in P-VMAT was significantly lower than that in JT IMRT and F-VMAT. Monitor unit (MU) of F-VMAT and P-VMAT was significantly lower than that of JT IMRT. ROC analysis showed that among JT IMRT, F-VMAT, and P-VMAT, PCTVi-L, and PCTVi-L/TLL had diagnostic power to predict the suitability of RT plans according to lung dose constraints of our department. For JT IMRT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 16.6 and 0.59. For F-VMAT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 16.75 and 0.62. For P-VMAT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 15.15 and 0.59. After Mann–Whitney U-test analysis, it was found that among the three plannings, the group with lower PCTVi-L and PCTVi-L/TLL could significantly reduce the dose of total lung and heart (p <0.05). Conclusion PCTVi-L <16.6 and PCTVi-L/TLL <0.59 for JT IMRT, PCTVi-L <16.75 and PCTVi-L/TLL <0.62 for F-VMAT and PCTVi-L <15.15, and PCTVi-L/TLL <0.59 for P-VMAT can predict whether patients with T-shaped UMEC can meet the lung dose limits of our department.
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Affiliation(s)
- Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Modern Physics, Fudan University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Institute of Modern Physics, Fudan University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanhua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Zhang Y, Jabbour SK, Zhang A, Liu B, Yue NJ, Biswal NC. Proton beam therapy can achieve lower vertebral bone marrow dose than photon beam therapy during chemoradiation therapy of esophageal cancer. Med Dosim 2021; 46:229-235. [PMID: 33454170 DOI: 10.1016/j.meddos.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/17/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023]
Abstract
Chemoradiation therapy plays an important role in both the neoadjuvant and definitive management of esophageal cancer (EC). Prior studies have suggested that advanced planning techniques can better spare organs at risk including the heart. Although multiple toxicities can result from esophageal radiotherapy, one less studied acute toxicity is that of myelosuppression, which can result, in part, from the combination of chemotherapy and incidental radiotherapy administration to the vertebral bodies (VBs), which abut the posterior aspect of the esophagus, especially in the lower thoracic esophagus. Traditionally, VB bone marrow doses are not accounted during EC radiation therapy planning. We sought to compare the doses to VBs between proton and photon radiation therapy as part of chemoradiation therapy for EC treatment. By reducing doses to the vertebrae, radiation therapy can decrease treatment-related myelosuppression, which can avoid delays or chemotherapy dose reductions in therapy, which likely affect long-term patient survival. Dose constraints are not routinely employed for bone marrow in radiation treatment planning. In our previous work, we identified thresholds to avoid grade ≥3 leukopenia, including VB V10Gy, VB V20Gy, and a mean VB dose (MVD) of 18.8 Gy. Herein we perform a retrospective dosimetric planning study comparing passive- or double-scattering proton beam therapy (PS-PBT), volumetric-modulated arc therapy (VMAT) (photon-based), and intensity-modulated radiation therapy (IMRT) (photon-based) in 25 patients with locally advanced EC who were treated originally with photon RT at our institution between 2011 and 2016. The aforementioned dose constraints were included in the retrospective planning process for PS-PBT, VMAT, and IMRT to determine the feasibility of achieving these VB constraints while maintaining reasonable target coverage and planned, consistent constraints to other organs at risk including lungs, spinal cord, and stomach. PS-PBT plans were found to achieve lower doses for VB V10Gy, V20Gy, and MVD than VMAT and static IMRT plans while achieving the same target coverage. PS-PBT resulted in lower organs at risk dosimetric parameters than the photon plans, with p < 0.0001. Student's paired t-test p-values in favor of proton therapy's ability to spare organs were as follows: for PS-PBT vs VMAT and PS-PBT vs IMRT in mean doses for lung, liver, and VB and VB V10Gy and VB V20Gy were all <0.001 (Bonferroni corrected α=0.017). One-way ANOVA found that VB doses (VB V10Gy, VB V20Gy, and MVD) were significantly lower for proton therapy (p < 0.006) among the 3 planning techniques.
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Affiliation(s)
- Yin Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Andrew Zhang
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Bo Liu
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Ning J Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA
| | - Nrusingh C Biswal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey 08901, USA; Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Vošmik M, Hodek M, Buka D, Sýkorová P, Grepl J, Paluska P, Paulíková S, Sirák I. Cardiotoxicity of radiation therapy in esophageal cancer. Rep Pract Oncol Radiother 2020; 25:318-322. [PMID: 32194352 PMCID: PMC7078499 DOI: 10.1016/j.rpor.2020.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/22/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
With a development of radiotherapeutic techniques, availability of radiotherapy data on cardiotoxicity, and slowly improving esophageal cancer outcomes, an increasing emphasis is placed on the heart protection in radiation treated esophageal cancer patients. Radiation induced heart complications encompass mainly pericardial disease, cardiomyopathy, coronary artery atherosclerosis, valvular heart disease, and arrhythmias. The most frequent toxicity is pericardial effusion which is usually asymptomatic in the majority of patients. The use of modern radiotherapy techniques is expected to reduce the risk of cardiotoxicity, although this expectation has to be confirmed by clinical data.
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Affiliation(s)
| | | | | | | | | | | | | | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
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Xu C, Guo L, Liao Z, Wang Y, Liu X, Zhao S, Wang J, Yuan Z, Wang P, Lin SH. Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy. Clin Transl Radiat Oncol 2019; 17:17-23. [PMID: 31080898 PMCID: PMC6506607 DOI: 10.1016/j.ctro.2019.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/07/2019] [Accepted: 04/13/2019] [Indexed: 12/13/2022] Open
Abstract
Dosimetric parameters for the heart and lung are associated with overall survival in esophageal cancer patients. Heart and lung doses were associated with cardiac and pulmonary complications. Patients with cardiac and pulmonary complications are strongly correlated with survival outcomes. Dosimetric relationship with clinical outcomes are predictive for surgical and non-surgical patients. Purpose To analyze associations between heart and lung dose and overall survival (OS) in patients with esophageal cancer who received concurrent chemo-radiotherapy (CCRT) with or without surgery. Patients and methods Patients received intensity-modulated radiation therapy (median dose 50.4 Gy) from 2004 through 2016. Cutoff points for continuous variables were calculated using the method of Contal and O’Quigley. Kaplan-Meier method with log-rank tests was used to calculate survival. OS was analyzed with both univariate and multivariable Cox models. Results In all, 560 patients were analyzed; median follow-up time was 29.3 months, and 5-year OS rate was 41.7%. Heart V30 >45% and mean lung dose (MLD) >10 Gy were found to be independently associated with worse survival after adjustment for other clinical and dosimetric factors (P < 0.05). Heart and lung doses were also found to be risk factors for radiation-induced cardiac and pulmonary complications (P < 0.05): 8.5% of patients with heart V30 ≤45% had cardiac complications vs. 15% for V30 >45% (P = 0.046); 18.8% of patients with MLD ≤10 Gy had pulmonary complications vs. 27% for MLD >10 Gy (P = 0.020). Having cardiac complications was associated with worse survival (5-year OS rates 27.6% with vs. 43.2% without, P = 0.012), and having pulmonary complications was associated with worse survival as well (5-year OS rates 23.1% with vs. 47.4% without, P < 0.001). Conclusion Both heart and lung doses independently predicted worse OS in patients with esophageal cancer, even after adjustment for other clinical and dosimetric factors, and were also risk factors for radiation-induced complications. Both irradiated heart and lung doses should be minimized as a whole.
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Affiliation(s)
- Cai Xu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lanwei Guo
- Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yifan Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiyou Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, Hubei, China
| | - Shuangtao Zhao
- Department of Radiation Oncology, Cancer Hospital & Institute, Chinese Academy of Medical Science, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Zhiyong Yuan
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ke TM, Fong Y, Lin LC, Chien YW, Yang CC, Lin CH, Lin KL, Que J. Evaluating the optimal radiation dose for definitive chemoradiotherapy for esophageal squamous cell carcinoma: A single institution experience. Medicine (Baltimore) 2018; 97:e13214. [PMID: 30431596 PMCID: PMC6257338 DOI: 10.1097/md.0000000000013214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The optimal radiation dose for definitive chemoradiotherapy in inoperable esophageal squamous cell carcinoma (ESCC) has been long debated. In this study, we evaluated the effect of doses greater than the conventional radiation dose (50.4 Gy) on tumor control, tumor response, overall survival (OS), and disease-free survival (DFS).The database of patients diagnosed with inoperable ESCC from 2007 to 2015 was obtained from the cancer registry of Chi-Mei Medical Center. All categorical variables were compared using Chi-squared test. The risk of OS and DFS were estimated using Cox proportional hazards regression, and Kaplan-Meier plots presented the trend of OS and DFS with log-rank tests used to compare differences. All significance levels were set at P < .05.A total of 84 patients were retrospectively analyzed, with 42 (50%) receiving >50.4 Gy and 42 (50%) receiving ≤50.4 Gy (50%) concurrently with chemotherapy. Univariate and multivariate analysis revealed no significant differences between higher dose and conventional dose in OS (P = .21) and DFS (P = .26). Further dose analysis of <50, 50 to 50.4, 51 to 60, and >60 Gy showed no significant differences in OS or DFS. Higher doses conveyed no significant benefit on the failure pattern, either local regional failure or distant failure (P = .42). Major prognostic factors associated with better OS on multivariate analysis were stages I and II patients (P = .03) and radiation technique using arc therapy (P = .04). No acute toxicity of grade III or higher was recorded.The results of our study show that providing higher than conventional radiation doses concurrent with chemotherapy for inoperable ESCC does not impact OS or DSF, nor does it improve locoregional failure or distant failure. Although tumor response might be improved by radiation doses >50.4 Gy, the impact on OS and DFS remain to be studied.
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Affiliation(s)
| | - Yao Fong
- Department of Thoracic Surgery, Chi-Mei Medical Center
| | - Li-Ching Lin
- Department of Radiation Oncology
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan
- School of Medicine, Taipei Medical University, Taipei
| | - Yu-Wun Chien
- Department of Public Health
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | | | | | | | - Jenny Que
- Department of Radiation Oncology
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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