title: Comparative outcomes for three-dimensional conformal versus intensity-modulated radiation therapy for esophageal cancer.
abstract: Emerging data suggests a benefit for using intensity modulated radiation therapy (IMRT) for the management of esophageal cancer. We retrospectively reviewed patients treated at our institution who received definitive or preoperative chemoradiation with either IMRT or 3D conformal radiation therapy (3DCRT) between October 2000 and January 2012. Kaplan Meier analysis and the Cox proportional hazard model were used to evaluate survival outcomes. We evaluated a total of 232 patients (138 IMRT, 94 3DCRT) who received a median dose of 50.4 Gy (range, 44-64.8) to gross disease. Median follow up for all patients, IMRT patients alone, and 3DCRT patients alone was 18.5 (range, 2.5-124.2), 16.5 (range, 3-59), and 25.9 months (range, 2.5-124.2), respectively. We observed no significant difference based on radiation technique (3DCRT vs. IMRT) with respect to median overall survival (OS) (median 29 vs. 32 months; P = 0.74) or median relapse free survival (median 20 vs. 25 months; P = 0.66). On multivariable analysis (MVA), surgical resection resulted in improved OS (HR 0.444; P < 0.0001). Superior OS was also associated on MVA with stage I/II disease (HR 0.523; P = 0.010) and tumor length ≤5 cm (HR 0.567; P = 0.006). IMRT was also associated on univariate analysis with a significant decrease in acute weight loss (mean 6% + 4.3% vs 9% + 7.4%, P = 0.012) and on MVA with a decrease in objective grade ≥3 toxicity, defined as any hospitalization, feeding tube, or >20% weight loss (OR 0.51; P = 0.050). Our data suggest that while IMRT-based chemoradiation for esophageal cancer does not impact survival there was significantly less toxicity. In the IMRT group there was significant decrease in weight loss and grade ≥3 toxicity compared to 3DCRT.
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: J
authors.initials: J
authors.lastname: Freilich
authors.forename: S E
authors.initials: SE
authors.lastname: Hoffe
authors.forename: K
authors.initials: K
authors.lastname: Almhanna
authors.forename: W
authors.initials: W
authors.lastname: Dinwoodie
authors.forename: B
authors.initials: B
authors.lastname: Yue
authors.forename: W
authors.initials: W
authors.lastname: Fulp
authors.forename: K L
authors.initials: KL
authors.lastname: Meredith
authors.forename: R
authors.initials: R
authors.lastname: Shridhar
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011830:Radiation Effects; D020266:Radiotherapy, Conformal / Q000379:methods* / Q000401:mortality*; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D000970:Antineoplastic Agents
keywords: 3-D conformal radiation; esophageal cancer; intensity-modulated radiation therapy