High-dose versus standard-dose radiotherapy with concurrent chemotherapy in stages II-III esophageal cancer.
OBJECTIVE
In this study, we investigated the effects of radiotherapy ≥60 Gy in the setting of concurrent chemo-radiotherapy for treating patients with Stages II-III esophageal cancer.


METHODS
A total of 126 patients treated with 5-fluorouracilbased concurrent chemo-radiotherapy between January 1998 and February 2008 were retrospectively reviewed. Among these patients, 49 received a total radiation dose of <60 Gy (standard-dose group), while 77 received a total radiation dose of ≥60 Gy (high-dose group). The median doses in the standard- and high-dose groups were 54 Gy (range, 45-59.4 Gy) and 63 Gy (range, 60-81 Gy), respectively.


RESULTS
The high-dose group showed significantly improved locoregional control (2-year locoregional control rate, 69 versus 32%, P < 0.01) and progression-free survival (2-year progression-free survival, 47 versus 20%, P = 0.01) than the standard-dose group. Median overall survival in the high- and the standard-dose groups was 28 and 18 months, respectively (P = 0.26). In multivariate analysis, 60 Gy or higher radiotherapy was a significant prognostic factor for improved locoregional control, progression-free survival and overall survival. No significant differences were found in frequencies of late radiation pneumonitis, post-treatment esophageal stricture or treatment-related mortality between the two groups.


CONCLUSIONS
High-dose radiotherapy of 60 Gy or higher with concurrent chemotherapy improved locoregional control and progression-free survival without a significant increase of in treatment-related toxicity in patients with Stages II-III esophageal cancer. Our study could provide the basis for future randomized clinical trials.
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul.
Yang-Gun
YG
Suh
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul.
Ik Jae
IJ
Lee
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul.
Wong Sub
WS
Koom
Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju.
Jihye
J
Cha
Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju.
Jong Young
JY
Lee
Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon, South Korea.
Soo Kon
SK
Kim
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul cglee1023@yuhs.ac.
Chang Geol
CG
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D000077143:Docetaxel; D004307:Dose-Response Relationship, Radiation; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D004940:Esophageal Stenosis / Q000209:etiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017671:Platinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D017564:Radiation Pneumonitis / Q000209:etiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D043823:Taxoids / Q000008:administration & dosage; D017211:Treatment Failure; D016896:Treatment Outcome
D017671:Platinum Compounds; D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil
chemotherapy; concurrent chemo-radiotherapy; esophageal cancer; radiotherapy