Efficacy analysis of simplified intensity-modulated radiotherapy with high or conventional dose and concurrent chemotherapy for patients with neck and upper thoracic esophageal carcinoma.
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 68.1 Gy was delivered in high dose group (hsIMRT group), and 60 Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9 Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54 Gy 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.
Department of Radiation Oncology, the Affiliated of Huai'an First Hospital to Nanjing Medical University, Nanjing, China.
Wei-Guo
WG
Zhu
Ke
K
Zhou
Chang-Hua
CH
Yu
Ji-Hua
JH
Han
Tao
T
Li
Xiao-Fei
XF
Chen
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000627:therapeutic use; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012074:Remission Induction; D013899:Thoracic Neoplasms / Q000473:pathology / Q000628:therapy*
D002945:Cisplatin; D005472:Fluorouracil