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Efficacy Analysis of Simplified Intensity-modulated Radiotherapy with High or Conventional Dose and Concurrent Chemotherapy for Patients with Neck and Upper Thoracic Esophageal Carcinoma

  • Zhu, Wei-Guo (Department of Radiation Oncology, Huai'an First Hospital, the Affiliated of Huai'an First Hospital to Nanjing Medical University) ;
  • Zhou, Ke (Department of Radiation Oncology, Huai'an First Hospital, the Affiliated of Huai'an First Hospital to Nanjing Medical University) ;
  • Yu, Chang-Hua (Department of Radiation Oncology, Huai'an First Hospital, the Affiliated of Huai'an First Hospital to Nanjing Medical University) ;
  • Han, Ji-Hua (Department of Radiation Oncology, Huai'an First Hospital, the Affiliated of Huai'an First Hospital to Nanjing Medical University) ;
  • Li, Tao (Department of Radiation Oncology, Huai'an First Hospital, the Affiliated of Huai'an First Hospital to Nanjing Medical University) ;
  • Chen, Xiao-Fei (Department of Radiation Oncology, Huai'an First Hospital, the Affiliated of Huai'an First Hospital to Nanjing Medical University)
  • Published : 2012.03.31

Abstract

For patients with neck and upper thoracic esophageal carcinoma, it is difficult to control lymph node metastases with conventional dose therapy. In this study, we assessed the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes. Three radiation treatment volumes were defined: PGTVnd, with which 68.1Gy was delivered in high dose group (hsIMRT group), and 60Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54Gy given to both groups. The sIMRT plan included 5 equi-angular coplanar beams. All patients received the cisplatin and 5-FU regimen concurrently with radiotherapy. The treatment was completed within six weeks and one case with grade three acute bronchitis was observed in hsIMRT group. For esophageal lesions, 80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P<0.05). The differences in 1-, 2- and 3-year relapse-free survival rates were all statistically significant (P<0.05). The major toxicity observed in both groups was Grade I~II leucopenia. sIMRT can generate a desirable dose distribution in treatment of neck and upper thoracic esophageal carcinoma with a better short-term efficacy. Boosted high dosing to metastatic lymph nodes can increase the relapse-free survival rate.

References

  1. Chandra A, Guerrero TM, Liu HH, et al (2005). Feasibility of using intensity-modulated radiotherapy to improve lung sparing in treatment planning for distal esophageal cancer. Radiother Oncol, 77, 247-53. https://doi.org/10.1016/j.radonc.2005.10.017
  2. Denham JW, Burmeister BH, Lamb DS, et al (1996). Factors influencing outcome following radio-chemotherapy for oesophageal cancer. The trans tasman radiation oncology group (trog). Radiother Oncol, 40, 31-43. https://doi.org/10.1016/0167-8140(96)01762-8
  3. Fenkell L, Kaminsky I, Breen S, et al (2008). Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus. Radiother Oncol, 89, 287-91. https://doi.org/10.1016/j.radonc.2008.08.008
  4. Fu WH, Wang LH, Zhou ZM, et al (2004). Comparison of conformal and intensity-modulated techniques for simultaneous integrated boost radiotherapy of upper esophageal carcinoma. World J Gastroenterol, 10, 1098-102. https://doi.org/10.3748/wjg.v10.i8.1098
  5. Geng H, Dai JR, Li YX, et al (2006). A simplified intensity modulated radiation therapy technique for difficult clinical cancer condition. Chin J Radiat Oncol, 15, 411-4.
  6. Kawahara K, Maekawa T, Okabayashi K, et al (1998). The number of lymph node metastases influences survival in esophageal cancer. J Surg Oncol, 67, 160-3. https://doi.org/10.1002/(SICI)1096-9098(199803)67:3<160::AID-JSO3>3.0.CO;2-7
  7. Korst RJ, Rusch VW, Venkatraman E, et al (1998). Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg, 115, 660-70. https://doi.org/10.1016/S0022-5223(98)70332-0
  8. Kurokawa T, Miyamoto M, Kato K, et al (2003). Overexpression of hypoxia-inducible-factor 1alpha (HIF-1alpha) in oesophageal squamous cell carcinoma correlates with lymph node metastasis and pathologic stage. Br J Cancer,89, 1042-7. https://doi.org/10.1038/sj.bjc.6601186
  9. Nutting CM, Bedford JL, Cosgrove VP, et al (2001). A comparison of conformal and intensity-modulated techniques for oesophageal radiotherapy. Radiother Oncol, 61, 157-63. https://doi.org/10.1016/S0167-8140(01)00438-8
  10. Palmer MK (1982). WHO handbook for reporting results of cancer treatment. Br J Cancer, 45, 484-5.
  11. Tachimori Y, Nagai Y, Kanamori N, et al (2011). Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus, 24, 33-8. https://doi.org/10.1111/j.1442-2050.2010.01086.x
  12. Tai P, Van Dyk J, Yu E, et al (2000). Radiation treatment for cervical esophagus: patterns of practice study in canada, 1996. Int J Radiat Oncol Biol Phys, 47, 703-12. https://doi.org/10.1016/S0360-3016(00)00484-3
  13. Tai P, Van Dyk J, Yu E, et al (1998). Variability of target volume delineation in cervical esophageal cancer. Int J Radiat Oncol Biol Phys, 42, 277-88.
  14. 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
  15. Xiao ZF, Yang ZY, Liang J, et al (2003). Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients. Ann Thorac Surg, 75, 331-6. https://doi.org/10.1016/S0003-4975(02)04401-6
  16. Xiao ZF, Yang ZY, Miao YJ, et al (2005). Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy: report of 549 cases. Int J Radiat Oncol Biol Phy, 62, 82-90. https://doi.org/10.1016/j.ijrobp.2004.08.046
  17. Wang SL, Liao Z, Liu H, et al (2006). Intensity-modulated radiation therapy with concurrent chemotherapy for locally advanced cervical and upper thoracic esophageal cancer. World J Gastroenterol, 12, 5501-8. https://doi.org/10.3748/wjg.v12.i34.5501
  18. Wan J, Xiao AQ, Gao SZ, et al (1989). Criteria of evaluation of immediate response of radiation therapy for esophageal carcinoma. Chin J Radiat Oncol, 3, 205-7.
  19. Watarai J, Kato T, Kobayashi M, et al (1992). Locoregional control for esophageal carcinoma treated with irradiation following surgery. Tohoku J Exp Med, 168, 591-8. https://doi.org/10.1620/tjem.168.591
  20. Wu VW, Kwong DL, Sham JS (2004). Target dose conformity in 3-dimensional conformal radiotherapy and intensity modulated radiotherapy. Radiother Oncol, 71, 201-6. https://doi.org/10.1016/j.radonc.2004.03.004

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