title: High-dose radiation therapy alone by moderate hypofractionation for patients with thoracic esophageal squamous cell carcinoma.
abstract: We conducted retrospective analyses to investigate the clinical outcome of thoracic esophageal cancer patients who were treated with high-dose radiation therapy (RT) alone by moderate hypofractionation due to medical unfitness or refusal to receive either surgery or chemo-radiotherapy.Between May 2003 and April 2013, 70 patients were treated with high-dose RT alone with curative aim. The planned total RT dose was 60 Gy in daily 3.0 Gy per fraction. We evaluated the survival outcome, toxicities, and prognostic factors affecting patients' survival.At the time of analysis, 32 patients experienced disease progression. The 2-year overall survival (OS), cancer-specific survival (CSS) and local control (LC) rates were 52.1%, 57.8%, and 68.2%, respectively. Among them, 25 patients had superficial (cT1a-b) esophageal cancers, and the 2-year OS, CSS, and LC rates were 80.0%, 87.3%, and 81.6%, respectively. Multivariate analysis revealed that cT disease (P < 0.001) and tumor location (P = 0.022) were the significant factors for OS. The incidence of grade 3 or higher toxicities were 9.9%, including grade 3 esophagitis (2 patients, 2.8%) and grade 4 or 5 trachea-esophageal fistula (5 patients, 7.1%).High-dose RT alone by moderate hypofractionation had led to reasonable clinical outcomes at acceptable toxicity risk in thoracic esophageal cancer patients who are medically unfit or refuse surgery or chemotherapy, especially for the patients having superficial lesion.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center Kangbuk Samsung Hospital Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dongryul
authors.initials: D
authors.lastname: Oh
authors.forename: Jae Myoung
authors.initials: JM
authors.lastname: Noh
authors.forename: Heerim
authors.initials: H
authors.lastname: Nam
authors.forename: Hyebin
authors.initials: H
authors.lastname: Lee
authors.forename: Tae Gyu
authors.initials: TG
authors.lastname: Kim
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069473:Radiation Dose Hypofractionation; D012189:Retrospective Studies