DOI QR코드

DOI QR Code

Moderately Hypofractionated Conformal Radiation Treatment of Thoracic Esophageal Carcinoma

  • Ma, Jin-Bo ;
  • Wei, Lin ;
  • Chen, Er-Cheng ;
  • Qin, Guang ;
  • Song, Yi-Peng ;
  • Chen, Xiang-Ming ;
  • Hao, Chuan-Guo
  • Published : 2012.08.31

Abstract

Aims: To prospectively assess the efficacy and safety of moderately hypofractionated conformal radiotherapy in patients with thoracic esophageal cancer. Methods and Materials: From Sept. 2002 to Oct, 2005, 150 eligible patients with T2-4N0-1M0 stage thoracic esophageal squamous cell cancers were enrolled to receive either conventional fractionated radiation (CFR) or moderately hypofractionated radiation (MHR) with a three-dimensional conformal radiation technique. Of the total, 74 received moderately hypofractionated radiation with total dose of 54-60Gy/18-20fractions for 3.5-4 weeks in the MHR arm, and 76 received conventional radiation with total dose of 60Gy/30 fractions for 6 weeks in the CFR arm. Concurrent chemotherapy comprised of paclitaxel and cisplatin. Safety was evaluated, and local control and overall survival rates were calculated. Results: Statistically significant differences between the CFR versus MHR arms were observed in local/regional failure rate (47.3% v 27.0%, P=0.034) and the percentage of patients with persistent local disease (26.3% v 10.8%, P=0.012). But 3 and 5-year overall survival rates (43.2%, 38.8% v 38.2%, 28.0%, respectively) were not different between the two arms (P=0.268). There were no significant differences in the incidences of grade 3 or higher acute toxicities (66.3% v 50.0%) and late complications rates (27.0% v 22.4%) between the MHR and CFR arms. Conclusions: Moderately hypofractionated, three-dimensional radiation treatment could improve the local control rate of esophageal cancer and potentially increase patients' survival.

Keywords

Chemoradiation;esophageal cancer;hypofractionated radiation

References

  1. Atsumi K, Shioyama Y, Nakamura K, et al (2010). Predictive factors of esophageal stenosis associated with tumor regression in radiation therapy for locally advanced esophageal cancer. J Radiat Res, 51, 9-14. https://doi.org/10.1269/jrr.09073
  2. Bao S, Wu Q, McLendon RE, et al (2006). Glioma stem cells promote radioresistance by preferential activation of the DNA damage response. Nature, 444, 756-60. https://doi.org/10.1038/nature05236
  3. Brunner T B, Rupp A, Melzner W, et al (2008). Esophageal cancer. A prospective phase II study of concomitant-boost external-beam chemoradiation with a top-up endoluminal boost. Strahlenther Onkol, 184, 15-22. https://doi.org/10.1007/s00066-008-1787-5
  4. Cooper JS, Guo MD, Herskovic A, et al (1999). Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA, 281, 1623-7. https://doi.org/10.1001/jama.281.17.1623
  5. Gaspar LE, Winter K, Kocha WI, et al (2000). A phase I/II study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207): final report. Cancer, 88, 988-95. https://doi.org/10.1002/(SICI)1097-0142(20000301)88:5<988::AID-CNCR7>3.0.CO;2-U
  6. Greene FL, Compton C, Fritz A, et al (2006). Esophagus., AJCC Cancer Staging Atlas. Springer Science+Business Media Inc, Chicago, pp. 77-88.
  7. Halperin EC, Perez CA, Brady LW, et al (2008). Biologic Basis of Radiation Therapy. In: McBride W.H. and Withers H.R. (eds.), Perez and Brady's principles and practice of radiation oncology. Lippincott Williams & Wilkins, Lippincott Williams & Wilkins, pp. 77-109.
  8. Hama Y, Uematsu M, Shioda A, et al (2002). Severe complications after hypofractionated high dose rate intracavitary brachytherapy following external beam irradiation for oesophageal carcinoma. Br J Radiol, 75, 238-42. https://doi.org/10.1259/bjr.75.891.750238
  9. Harney J, Goodchild K, Phillips H, et al (2003). A phase I/II study of CHARTWEL with concurrent chemotherapy in locally advanced, inoperable carcinoma of the oesophagus. Clin Oncol (R Coll Radiol), 15, 109-14. https://doi.org/10.1053/clon.2003.0200
  10. Hermann PC, Huber SL, Herrler T, et al (2007). Distinct populations of cancer stem cells determine tumor growth and metastatic activity in human pancreatic cancer. Cell Stem Cell, 1, 313-23. https://doi.org/10.1016/j.stem.2007.06.002
  11. Kassam Z, Wong RK, Ringash J, et al (2008). A phase I/II study to evaluate the toxicity and efficacy of accelerated fractionation radiotherapy for the palliation of dysphagia from carcinoma of the oesophagus. Clin Oncol (R Coll Radiol), 20, 53-60. https://doi.org/10.1016/j.clon.2007.10.003
  12. Kawaguchi Y, Nishiyama K, Miyagi K, et al (2011). Patterns of failure associated with involved field radiotherapy in patients with clinical stage I thoracic esophageal cancer. Jpn J Clin Oncol, 41, 1007-12. https://doi.org/10.1093/jjco/hyr069
  13. Khurana R, Dimri K, Lal P, et al (2007). Factors influencing the development of ulcers and strictures in carcinoma of the esophagus treated with radiotherapy with or without concurrent chemotherapy. J Cancer Res Ther, 3, 2-7. https://doi.org/10.4103/0973-1482.31963
  14. Lee Y, Auh SL, Wang Y, et al (2009). Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood, 114, 589-95. https://doi.org/10.1182/blood-2009-02-206870
  15. Minsky BD, Pajak TF, Ginsberg RJ, et al (2002). INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: highdose versus standard-dose radiation therapy. J Clin Oncol, 20, 1167-74. https://doi.org/10.1200/JCO.20.5.1167
  16. Nguyen GH, Murph MM, Chang J Y (2011). Cancer Stem Cell Radioresistance and Enrichment: Where Frontline Radiation Therapy May Fail in Lung and Esophageal Cancers. Cancers (Basel), 3, 1232-52. https://doi.org/10.3390/cancers3011232
  17. Seung SK, Smith JW, 2nd, Ross HJ (2008). Selective dose escalation of chemoradiotherapy for locally advanced esophageal cancer. Dis Esophagus, 21, 589-95. https://doi.org/10.1111/j.1442-2050.2008.00822.x
  18. Song YP, Ma JB, Hu LK, et al (2011). Phase I/II study of hypofractioned radiation with three-dimensional conformal radiotherapy for clinical T3-4N0-1M0 stage esophageal carcinoma. Technol Cancer Res Treat, 10, 25-30. https://doi.org/10.7785/tcrt.2012.500176
  19. Sykes A J, Burt P A, Slevin N J, et al (1998). Radical radiotherapy for carcinoma of the oesophagus: an effective alternative to surgery. Radiother Oncol, 48, 15-21. https://doi.org/10.1016/S0167-8140(98)00037-1
  20. Trotti A, Colevas AD, Setser A, et al (2003). CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol, 13, 176-81. https://doi.org/10.1016/S1053-4296(03)00031-6
  21. Vogelius IS, Westerly DC, Cannon GM, Bentzen SM (2010). Hypofractionation does not increase radiation pneumonitis risk with modern conformal radiation delivery techniques. Acta Oncol, 49, 1052-7. https://doi.org/10.3109/0284186X.2010.498835
  22. Vuong T, Szego P, David M, et al (2005). The safety and usefulness of high-dose-rate endoluminal brachytherapy as a boost in the treatment of patients with esophageal cancer with external beam radiation with or without chemotherapy. Int J Radiat Oncol Biol Phys, 63, 758-64. https://doi.org/10.1016/j.ijrobp.2005.02.042
  23. Zhao KL, Ma JB, Liu G, et al (2010). Three-dimensional conformal radiation therapy for esophageal squamous cell carcinoma: is elective nodal irradiation necessary? Int J Radiat Oncol Biol Phys, 76, 446-51. https://doi.org/10.1016/j.ijrobp.2009.02.078

Cited by

  1. High-dose radiation therapy alone by moderate hypofractionation for patients with thoracic esophageal squamous cell carcinoma vol.95, pp.33, 2016, https://doi.org/10.1097/MD.0000000000004591