Concurrent three-dimensional conformal radiotherapy and chemotherapy for postoperative recurrence of mediastinal lymph node metastases in patients with esophageal squamous cell carcinoma: a phase 2 single-institution study.
OBJECTIVE
The aim of this study was to evaluate the effects of radiotherapy plus concurrent weekly cisplatin chemotherapy on the postoperative recurrence of mediastinal lymph node metastases in esophageal cancer patients.


METHODS
Ninety-eight patients were randomly enrolled to receive either three-dimensional conformal radiotherapy alone (group A) or concurrent chemoradiotherapy (group B). A radiation dose of 62-70 Gy/31-35 fractions was delivered to the recurrent tumor. Furthermore, the patients in group B simultaneously received weekly doses of cisplatin (30 mg/m(2)), and the survival outcomes and toxic effects were compared.


RESULTS
The response rate of group B (91.8%) was significantly greater than that of group A (73.5%) (χ(2) = 5.765, P = 0.016). The 1- and 3-year survival rates of group B (85.7% and 46.9%, respectively) were also greater than those of group A (69.4% and 28.6%, respectively). However, there were no significant differences in the 5-year survival rates. The numbers of patients who died of distant metastases in groups A and B were 13 (26.5%) and 5 (10.2%), respectively (χ(2) = 4.356, P = 0.036). Acute radiation-related esophagitis and granulocytopenia in group B was frequent. However, intergroup differences in terms of late toxicity were not significant.


CONCLUSIONS
Three-dimensional conformal radiotherapy (3DCRT) is a practical and feasible technique to treat the recurrence of mediastinal lymph node metastases of postoperative esophageal cancer. In addition, concurrent chemotherapy can increase local tumor control, decrease the distant metastasis rate, and increase the long-term survival rate.
Dai-yuan
DY
Ma
Bang-xian
BX
Tan
Mi
M
Liu
Xian-fu
XF
Li
Ye-qin
YQ
Zhou
Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, 37 Guoxue Lane, Chengdu, P,R, China. radyoulu@hotmail.com.
You
Y
Lu
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D011184:Postoperative Period; D020266:Radiotherapy, Conformal / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods; D012008:Recurrence; D016019:Survival Analysis
D002945:Cisplatin