Clinical outcome of definitive radiation therapy for superficial esophageal cancer.
OBJECTIVE
To analyze the clinical outcome of concurrent chemoradiotherapy in superficial esophageal cancer patients.


METHODS
We retrospectively analyzed data for 123 patients with superficial esophageal cancer who received external beam radiotherapy without intracavitary brachytherapy plus systemic chemotherapy during 1998-2015. Elective nodal irradiation was not performed. The dosage to planning treatment volume was 60 Gy in 30 fractions. The main outcome measure was overall survival.


RESULTS
Patient characteristics were as follows: median age, 66 (41-83) years; male/female ratio, 106/17; squamous cell carcinoma/other, 122/1; cT1a/cT1b, 27/96; cervical esophagus/upper thoracic esophagus/middle thoracic esophagus/lower thoracic esophagus, 7/9/66/41 and concurrent chemoradiotherapy/radiotherapy alone, 100/23. Cisplatin and 5-fluorouracil were the most commonly used agents (85%). At the last follow-up (median 60.5 months), 91 (74%) patients were alive. Complete response was achieved in 116 (94.4%) patients. The 5-year overall survival, progression-free survival and local control rates were 77.0, 46.9 and 62.7%, respectively, similar to that in the elderly patients (P = 0.878, 0.754 and 0.648, respectively). There were 55 failures: 42 local, 10 regional and 3 distant failures. Nine local and seven regional failures developed out-of-field. Thirty-eight local failures (90%) were successfully salvaged, of which 30 (71%) were salvaged via endoscopic removal; only 2 regional failures (20%) were salvaged. Fifteen G3 acute toxicities occurred. One pneumonitis (G3), one pneumothorax (G3) and two pericardial effusion (G2) were the late toxicities observed. There were no G4 toxicities or treatment-related deaths.


CONCLUSIONS
Concurrent chemoradiotherapy without intracavitary brachytherapy was effective and safe for superficial esophageal cancer, even in elderly patients.
Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Yutaro
Y
Koide
Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Takeshi
T
Kodaira
Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Hiroyuki
H
Tachibana
Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Natsuo
N
Tomita
Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Chiyoko
C
Makita
Department of Radiation Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Makoto
M
Itoh
Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Tetsuya
T
Abe
Department of Clinical Oncology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Kei
K
Muro
Department of Endoscopy, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Masahiro
M
Tajika
Department of Endoscopy, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya.
Yasumasa
Y
Niwa
Department of Radiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
Yoshiyuki
Y
Itoh
Department of Radiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
Shinji
S
Naganawa
D000368:Aged; D000369:Aged, 80 and over; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016879:Salvage Therapy; D016896:Treatment Outcome
D002945:Cisplatin; D005472:Fluorouracil
aged; chemoradiotherapy; elderly; esophageal neoplasms; lymphatic irradiation; toxicity