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Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institutional retrospective study.

Yamashita H, Takenaka R, Omori M, Imae T, Okuma K, Ohtomo K, Nakagawa K - Radiat Oncol (2015)

Bottom Line: Between 2000 and 2011, ENI was used for all cases excluding high age cases.The median follow-up time for survivors was 34.0 months.IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yamachan07291973@yahoo.co.jp.

ABSTRACT

Background: This retrospective study on early and locally advanced esophageal cancer was conducted to evaluate locoregional failure and its impact on survival by comparing involved field radiotherapy (IFRT) with elective nodal irradiation (ENI) in combination with concurrent chemotherapy.

Methods: We assessed all patients with esophageal cancer of stages I-IV treated with definitive radiotherapy from June 2000 to March 2014. Between 2000 and 2011, ENI was used for all cases excluding high age cases. After Feb 2011, a prospective study about IFRT was started, and therefore IFRT was used since then for all cases. Concurrent chemotherapy regimen was nedaplatin (80 mg/m(2) at D1 and D29) and 5-fluorouracil (800 mg/m(2) at D1-4 and D29-32).

Results: Of the 239 consecutive patients assessed (120 ENI vs. 119 IFRT), 59 patients (24.7%) had stage IV disease and all patients received at least one cycle of chemotherapy. The median follow-up time for survivors was 34.0 months. There were differences in 3-year local control (44.8% vs. 55.5%, p = 0.039), distant control (53.8% vs. 69.9%, p = 0.021) and overall survival (34.8% vs. 51.6%, p = 0.087) rates between ENI vs. IFRT, respectively. Patients treated with IFRT (8 %) demonstrated a significantly lower risk (p = 0.047) of high grade late toxicities than with ENI (16%). IFRT did not increase the risk of initially uninvolved or isolated nodal failures (27.5% in ENI and 13.4% in IFRT).

Conclusions: Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients. Both tendencies of improved loco-regional progression-free survival and a significant increased overall survival rate favored the IFRT arm over the ENI arm in this study.

No MeSH data available.


Related in: MedlinePlus

Local progression-free survival curves for patients with IFRT or ENI. Gray line = IFRT arm, black line = ENI arm, circle = censored value
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Fig2: Local progression-free survival curves for patients with IFRT or ENI. Gray line = IFRT arm, black line = ENI arm, circle = censored value

Mentions: Ninety-one patients remained alive at the time of analysis, with a median follow-up of 34.0 months in survivors (2.0 – 154 months). The median LPFS time was not available in the IFRT arm. The 1-, 2-, and 3-year LPFS rates were 58.9, 51.3, and 44.8 %, respectively, in the ENI arm, versus 73.0, 61.0, and 55.5 % in the IFRT arm (p = 0.039 by log-rank test) as shown in Fig. 2. The 1-, 2-, and 3-year distant metastasis-free survival rates were 66.1, 56.5, and 53.8 %, respectively, in the ENI arm, versus 82.4, 69.9, and 69.9 % in the IFRT arm (p = 0.021).Fig. 2


Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institutional retrospective study.

Yamashita H, Takenaka R, Omori M, Imae T, Okuma K, Ohtomo K, Nakagawa K - Radiat Oncol (2015)

Local progression-free survival curves for patients with IFRT or ENI. Gray line = IFRT arm, black line = ENI arm, circle = censored value
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4554303&req=5

Fig2: Local progression-free survival curves for patients with IFRT or ENI. Gray line = IFRT arm, black line = ENI arm, circle = censored value
Mentions: Ninety-one patients remained alive at the time of analysis, with a median follow-up of 34.0 months in survivors (2.0 – 154 months). The median LPFS time was not available in the IFRT arm. The 1-, 2-, and 3-year LPFS rates were 58.9, 51.3, and 44.8 %, respectively, in the ENI arm, versus 73.0, 61.0, and 55.5 % in the IFRT arm (p = 0.039 by log-rank test) as shown in Fig. 2. The 1-, 2-, and 3-year distant metastasis-free survival rates were 66.1, 56.5, and 53.8 %, respectively, in the ENI arm, versus 82.4, 69.9, and 69.9 % in the IFRT arm (p = 0.021).Fig. 2

Bottom Line: Between 2000 and 2011, ENI was used for all cases excluding high age cases.The median follow-up time for survivors was 34.0 months.IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. yamachan07291973@yahoo.co.jp.

ABSTRACT

Background: This retrospective study on early and locally advanced esophageal cancer was conducted to evaluate locoregional failure and its impact on survival by comparing involved field radiotherapy (IFRT) with elective nodal irradiation (ENI) in combination with concurrent chemotherapy.

Methods: We assessed all patients with esophageal cancer of stages I-IV treated with definitive radiotherapy from June 2000 to March 2014. Between 2000 and 2011, ENI was used for all cases excluding high age cases. After Feb 2011, a prospective study about IFRT was started, and therefore IFRT was used since then for all cases. Concurrent chemotherapy regimen was nedaplatin (80 mg/m(2) at D1 and D29) and 5-fluorouracil (800 mg/m(2) at D1-4 and D29-32).

Results: Of the 239 consecutive patients assessed (120 ENI vs. 119 IFRT), 59 patients (24.7%) had stage IV disease and all patients received at least one cycle of chemotherapy. The median follow-up time for survivors was 34.0 months. There were differences in 3-year local control (44.8% vs. 55.5%, p = 0.039), distant control (53.8% vs. 69.9%, p = 0.021) and overall survival (34.8% vs. 51.6%, p = 0.087) rates between ENI vs. IFRT, respectively. Patients treated with IFRT (8 %) demonstrated a significantly lower risk (p = 0.047) of high grade late toxicities than with ENI (16%). IFRT did not increase the risk of initially uninvolved or isolated nodal failures (27.5% in ENI and 13.4% in IFRT).

Conclusions: Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients. Both tendencies of improved loco-regional progression-free survival and a significant increased overall survival rate favored the IFRT arm over the ENI arm in this study.

No MeSH data available.


Related in: MedlinePlus