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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

Overall survival curves for patients with stages I, II, III, and IV
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Fig4: Overall survival curves for patients with stages I, II, III, and IV

Mentions: The median survival time (MST) was 21.3 months [95 % confidence interval (CI), 16.1–26.5 months] in the ENI arm versus 38.9 months in the IFRT arm (95 % CI, 14.9–62.8 months). The 1-, 2-, and 3-year overall survival (OS) rates were 65.8, 45.8, and 34.8 %, respectively, in the ENI arm, versus 70.8, 58.7, and 51.6 % in the IFRT arm (Fig. 3). There was no statistical difference in overall survival between the two arms (p = 0.087). The 1-, 2-, and 3-year OS rates were 92.5, 78.0, and 67.6 % in stage I, 73.9, 64.5, and 53.9 % in stage II, 63.2, 46.6, and 33.3 % in stage III, and 54.8, 30.6, and 23.5 % in stage IV (p < 0.0001), respectively, as shown in Fig. 4 and Table 3. Besides this, there was significantly statistical difference in OS among clinical T stages (p < 0.0001), between ≥ 70 and < 70 years old (p = 0.049), and among one, two, three, and four cycles of chemotherapy (p = 0.0004) (Table 3). There was no statistical difference in OS between SqCC and other histopathological types (p = 0.64), among primary tumor locations (p = 0.56), and between 50 Gy and other doses (p = 0.82).Fig. 3


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)

Overall survival curves for patients with stages I, II, III, and IV
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Overall survival curves for patients with stages I, II, III, and IV
Mentions: The median survival time (MST) was 21.3 months [95 % confidence interval (CI), 16.1–26.5 months] in the ENI arm versus 38.9 months in the IFRT arm (95 % CI, 14.9–62.8 months). The 1-, 2-, and 3-year overall survival (OS) rates were 65.8, 45.8, and 34.8 %, respectively, in the ENI arm, versus 70.8, 58.7, and 51.6 % in the IFRT arm (Fig. 3). There was no statistical difference in overall survival between the two arms (p = 0.087). The 1-, 2-, and 3-year OS rates were 92.5, 78.0, and 67.6 % in stage I, 73.9, 64.5, and 53.9 % in stage II, 63.2, 46.6, and 33.3 % in stage III, and 54.8, 30.6, and 23.5 % in stage IV (p < 0.0001), respectively, as shown in Fig. 4 and Table 3. Besides this, there was significantly statistical difference in OS among clinical T stages (p < 0.0001), between ≥ 70 and < 70 years old (p = 0.049), and among one, two, three, and four cycles of chemotherapy (p = 0.0004) (Table 3). There was no statistical difference in OS between SqCC and other histopathological types (p = 0.64), among primary tumor locations (p = 0.56), and between 50 Gy and other doses (p = 0.82).Fig. 3

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