scholarly journals Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma without hypopharyngeal invasion: dose distribution and clinical outcome

2019 ◽  
Vol 60 (4) ◽  
pp. 517-526 ◽  
Author(s):  
Yuichi Ishida ◽  
Katsuyuki Sakanaka ◽  
Kota Fujii ◽  
Satoshi Itasaka ◽  
Takashi Mizowaki
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Initial Recurrence ◽  
Upper Cervical

AbstractHypopharyngeal invasion would be a key finding in determining the extent of the irradiation fields in patients with cervical esophageal squamous cell carcinoma (CESCC). This study aimed to investigate the clinical outcomes of chemoradiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) omitting upper cervical lymph nodal irradiation in CESCC without hypopharyngeal invasion, and the dosimetric superiority of SIB-IMRT to 3D conformal radiotherapy (3DCRT). We retrospectively identified 21 CESCC patients without hypopharyngeal invasion [clinical Stage I/II/III/IV (M1LYM); 3/6/5/7] (UICC-TNM 7th edition) who underwent chemoradiotherapy using SIB-IMRT between 2009 and 2015. SIB-IMRT delivered 60 Gy to each primary tumor and the metastatic lymph nodes, and 48 Gy to elective lymph nodal regions, including Levels III and IV of the neck, supraclavicular, and upper mediastinal lymphatic regions, in 30 fractions. The overall survival rate, locoregional control rate, and initial recurrence site were evaluated. 3DCRT plans were created to perform dosimetric comparisons with SIB-IMRT. At a median follow-up of 64.5 months, the 5-year locoregional control and overall survival rates were 66.7% and 53.4%, respectively. Disease progressed in eight patients: all were locoregional progressions and no patients developed distant progression including upper cervical lymph nodal regions as initial recurrence sites. The planning study showed SIB-IMRT improved target coverage without compromising the dose to the organs at risk, compared with 3DCRT. In conclusion, omitting the elective nodal irradiation of the upper cervical lymph nodes was probably reasonable for CESCC patients without hypopharyngeal invasion. Locoregional progression remained the major progression site in this population.

Nomogram predicting long-term survival probability of thoracic esophageal squamous cell carcinoma after radical esophagectomy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4094-4094
Author(s):  
Weimin Mao ◽  
Xinming Zhou ◽  
Qixun Chen ◽  
Youhua Jiang ◽  
Xun Yang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Regression Model ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Radical Esophagectomy ◽  
Term Survival

4094 Background: Nomograms have been widely and successfully used for numerous cancers to obtain reliable prognostic information for each individual patient.To date, however, no studies have conducted survival estimates using nomograms for esophageal squamous-cell carcinoma (ESCC) in Chinese population.The purpose of this study is to develop a nomogram to predict the long-term survival probabilities in patients diagnosed with ESCC after radical esophagectomy. Methods: This study involves a dataset containing 1923 patients who underwent radical esophagectomy for ESCC at Zhejiang Cancer Hospital in Hangzhou, China. Among them, 1,578 patients with no missing data were used to build a prognostic nomogram based on Cox proportional hazard regression model. A multivariate survival analysis using Cox regression model was applied to identify significant variables with P-values <0.05. On the basis of the predictive model with the identified variables, a nomogram was constructed for predicting five-year and ten-year overall survival probabilities. The prediction model was internally validated using bootstrap resampling, assessing its optimism-corrected discrimination and calibration. Results: The median of overall survival times of 1578 ESCC patients was 35.6 months, and the 5-year and 10-year survival rate was 32% and 20%, respectively. The multivariate Cox model identified alcohol, tumor length, surgical approach, number of surgical removed lymph node, ratio of metastatic lymph nodes, region of lymph nodes dissection, depth of invasion, differentiation of tumor, postoperative complications as covariates significantly associated with survival. Across the 100 bootstrap replicates, the median optimism-corrected summary C-index for predicting survival was 0.713 (SE=0.011). Conclusions: A nomogram predicting 5- and 10-year overall survival after radical esophagectomy for ESCC in Chinese population was constructed and validated based on nine significant variables. The nomogram can be applied in daily clinical practice for individualized survival prediction of ESCC patients after potentially curative esophagectomy.

scholarly journals Definitive Simultaneous Integrated Boost Versus Conventional-Fractionated Intensity Modulated Radiotherapy for Patients With Advanced Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Chen Li ◽  
Lijun Tan ◽  
Xiao Liu ◽  
Xin Wang ◽  
Zongmei Zhou ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Propensity Score ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Clinical Stage ◽  
Intensity Modulated Radiotherapy ◽  
Simultaneous Integrated Boost ◽  
Intensity Modulated ◽  
Integrated Boost

BackgroundThe aim of this study was to compare the effects of simultaneous integrated boost–intensity modulated radiotherapy (SIB-IMRT) and conventional fractionated-IMRT (CF-IMRT) for patients with esophageal squamous cell carcinoma (ESCC).MethodsThe data of 1173 patients treated with either CF-IMRT or SIB-IMRT for a curative intent from 2005 to 2016 were retrospectively reviewed. Propensity score matching (PSM) was used to create a well-balanced cohort of 687 patients at 1:2 ratio (237 patients in SIB-IMRT group and 450 patients in CF-IMRT group). Overall survival (OS), progression-free survival (PFS), recurrence pattern, and toxicity profiles were evaluated and compared between the two groups after PSM.ResultsAfter a median follow-up time of 42.3 months (range, 3.0-153.2 months) for surviving patients, survival results were comparable in the two groups. After PSM, the 1-year, 2-year and 4-year OS rates in the SIB-IMRT and CF-IMRT groups were 70.0% vs. 66.4%, 41.9% vs. 41.7% and 30.2% vs. 27.6%, respectively (p = 0.87). The 1-year, 2-year and 4-year PFS rates were 48.4% vs. 49.1%, 31.2% vs. 29.4%, and 26.1% vs. 17.9%, respectively (p = 0.64). Locoregional recurrence (p = 0.32) and distant metastasis (p = 0.54) rates were also comparable between two groups. The toxicity profile was similar in the two groups. Multivariate analyses in the matched samples showed that female, concurrent chemotherapy and earlier clinical stage were independently associated with longer OS and PFS.ConclusionsSIB-IMRT appears to be equivalent to CF-IMRT in treatment efficacy and safety, and could become an alternative option for definitive radiotherapy of ESCC.

scholarly journals Concurrent Chemoradiotherapy Versus Radiation Monotherapy for Patients with Locally Advanced Esophageal Squamous Cell Carcinoma in the Era of Intensity Modulated Radiotherapy: A Propensity Score-matched Analysis

2020 ◽  
Author(s):  
Chen Li ◽  
Lijun Tan ◽  
Xiao Liu ◽  
Xin Wang ◽  
Zongmei Zhou ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Concurrent Chemoradiotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Concurrent Chemotherapy ◽  
Intensity Modulated ◽  
Radiotherapy Alone

Abstract Background: To investigate the survival benefit of concurrent chemoradiotherapy for patients with locally advanced esophageal squamous cell carcinoma during the years of intensity-modulated radiotherapy. Methods: Medical records of 1273 patients with esophageal squamous cell carcinoma who received intensity-modulated radiotherapy from January 2005 to December 2017 in the CAMS were retrospectively reviewed. 683 patients received concurrent chemoradiotherapy, 590 patients received radiotherapy alone. Propensity score matching (PSM) method was used to eliminate baseline differences between the two groups. Survival and toxicity profile were evaluated afterwards. Results: After a median follow-up time of 50.4 months (3.2-157.4 months), both overall survival and progression-free survival of the concurrent chemoradiotherapy group were better than those of the radiotherapy group, either before or after PSM. After PSM, the 1-, 3-, 5-year OS of radiotherapy and concurrent chemoradiotherapy groups were 63.3% vs 72.2%, 31.6% vs 42.2% and 28.5% vs 38.1%, respectively (p=0.003). The 1-year, 3-year and 5-year PFS rates of radiotherapy and concurrent chemoradiotherapy group were 44.3% vs 48.6%, 23.4% vs 31.2% and 15.8% vs 25.2%, respectively (p=0.002). The rates of ≥ grade 3 leukopenia and radiation esophagitis in the concurrent chemoradiotherapy were higher than those in the radiotherapy alone group (p<0.05). There was no significant difference in the probability of radiation pneumonia between the two groups (p=0.359). Multivariate logistic regression analysis showed ≥ 70 years old, female, KPS ≤ 70, stage I-II, and patients diagnosed at earlier years (2005-2010) had lower probability of receiving concurrent chemoradiation (p<0.05). Multivariate Cox analysis indicated that female, stage I-II, EQD2≥60Gy and concurrent chemotherapy were favorable prognostic factors for both OS and PFS. Conclusions: Concurrent chemotherapy can bring survival benefits to patients with locally advanced esophageal squamous cell carcinoma receiving intensity-modulated radiotherapy. For patients who cannot tolerate concurrent chemotherapy, radiation monotherapy is an effective alternative with promising results.

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