title: Radiation dose escalation by simultaneous modulated accelerated radiotherapy combined with chemotherapy for esophageal cancer: a phase II study.
abstract: The outcomes for patients with esophageal cancer (EC) underwent standard-dose radical radiotherapy were still disappointing. This phase II study investigated the feasibility, safety and efficacy of radiation dose escalation using simultaneous modulated accelerated radiotherapy (SMART) combined with chemotherapy in 60 EC patients. Radiotherapy consisted of 66Gy at 2.2 Gy/fraction to the gross tumor and 54Gy at 1.8 Gy/fraction to subclinical diseases simultaneously. Chemotherapy including cisplatin and 5fluorouracil were administered to all patients during and after radiotherapy. The data showed that the majority of patients (98.3%) completed the whole course of radiotherapy and concurrent chemotherapy. The most common ≥ grade 3 acute toxicities were neutropenia (16.7%), followed by esophagitis (6.7%) and thrombopenia (5.0%). With a median follow-up of 24 months (5-38) for all patients and 30 months (18-38) for those still alive, 11 patients (18.3%) developed ≥ Grade 3 late toxicities and 2 (3.3%) of them died subsequently due to esophageal hemorrhage. The 1- and 2-year local-regional control, distant metastasis-free survival, disease-free survival and overall survival rates were 87.6% and 78.6%, 86.0% and 80.5%, 75.6% and 64.4%, 86.7% and 72.7%, respectively. SMART combined with concurrent chemotherapy is feasible in EC patients with tolerable acute toxicities. They showed a trend of significant improvements in local-regional control and overall survival. Further follow-up is needed to evaluate the late toxicities.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.|CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom.
authors.forename: Jianzhou
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Tiantian
authors.initials: T
authors.lastname: Zhai
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chang
authors.affiliation: Department of Oncology, The University of Hongkong - Shenzhen Hospital, Shenzhen, Guangdong, China.
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Ruihong
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Wuzhe
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Lin
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Longjia
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Mingzhen
authors.initials: M
authors.lastname: Zhou
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Derui
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Chuangzhen
authors.initials: C
authors.lastname: Chen
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: dose escalation; esophageal cancer; radiation therapy; simultaneous integrated boost; simultaneous modulated accelerated radiotherapy