Dose escalation intensity-modulated radiotherapy-based concurrent chemoradiotherapy is effective for advanced-stage thoracic esophageal squamous cell carcinoma.

Abstract

PURPOSE:

No studies have investigated the effects of irradiation-dose escalation intensity-modulated radiotherapy (IMRT)-based concurrent chemoradiotherapy (CCRT) in patients with thoracic esophageal squamous cell carcinoma (TESCC).

PATIENTS AND METHODS:

We analyzed data from patients with TESCC who were enrolled in the Taiwan Cancer Registry database. To compare treatment outcomes, the patients were categorized into two groups according to their radiotherapy doses: group 1, who received CCRT<60Gy with IMRT, and group 2, who received CCRT≥60Gy with IMRT. Group 1 was used as the control for investigating posttreatment mortality risk.

RESULTS:

We enrolled 2061 patients with TESCC without distant metastasis who received CCRT with IMRT. Multivariate Cox regression analysis indicated that advanced clinical American Joint Committee on Cancer (AJCC) stage (≥IIIA), alcohol consumption, and cigarette smoking were significant, poor independent predictors in patients with TESCC receiving IMRT-based CCRT. IMRT-based CCRT (≥60Gy; adjusted hazard ratio [aHR]: 0.75; 95% confidence interval [CI]: 0.63-0.83) was a significant independent prognostic factor for overall survival (P<0.0001). After adjustment for confounders, the aHRs (95% CIs) for overall mortality at all clinical stages were 0.75 (0.68-0.83, P<0.0001) in group 2. In group 2, the aHRs (95% CIs) for overall mortality at early (IA-IIB) and advanced (IIIA-IIIC) AJCC clinical stages were 0.89 (0.70-1.04, P=0.1905) and 0.75 (0.67-0.83, P<0.0001), respectively.

CONCLUSION:

Compared with standard-dose IMRT-based CCRT, high-dose IMRT-based CCRT yields more favorable survival outcomes in patients with advanced-stage TESCC.

• Authors: Chia-Lun Chang, Hsieh-Chih Tsai, Wei-Cheng Lin, Jer-Hwa Chang, Han-Lin Hsu, Jyh-Ming Chow, Kevin Sheng-Po Yuan, Alexander T H Wu, Szu-Yuan Wu
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 125 Issue 1 Pg. 73-79 (10 2017) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 28923576 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 Elsevier B.V. All rights reserved.

Topics

• Adult
• Aged
• Carcinoma, Squamous Cell (drug therapy, pathology, radiotherapy)
• Chemoradiotherapy
• Cohort Studies
• Databases, Factual
• Dose-Response Relationship, Radiation
• Esophageal Neoplasms (drug therapy, pathology, radiotherapy)
• Esophageal Squamous Cell Carcinoma
• Female
• Humans
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Staging
• Proportional Hazards Models
• Radiotherapy, Intensity-Modulated
• Thorax (pathology)
• Treatment Outcome