High dose radiation with chemotherapy followed by salvage esophagectomy among patients with locally advanced esophageal squamous cell carcinoma.
Locoregional failure is a major problem associated with chemoradiation treatment for squamous cell esophageal carcinoma. The aim of this study was to assess the feasibility, efficacy, and toxicity of preoperative radiation (dose > 50 Gy) with platinum-based chemotherapy followed by esophagectomy in locally advanced squamous cell carcinoma.



Data of patients with cT2-cT4 or node positive squamous cell carcinoma of the esophagus who received trimodality treatment between February 2006 and June 2015 were reviewed.



Forty-four patients were treated with intensity-modulated radiation therapy, volumetric-modulated arc therapy or three-dimensional radiation therapy. The median radiation dose was 60 Gy. The average volume of the lungs receiving 10 Gy was 48.1%, 20 Gy was 24.5%, and the average mean lung dose was 14 Gy. After chemoradiation, R0 resection was achieved in 31 patients (71%). Patients who received >60 Gy had a higher pathologic complete remission rate than those in the lower dose group (59.1% vs. 36.4%). R0 resection and radiation dose >60 Gy were associated with better overall survival in Cox proportional hazards regression analysis. The median follow-up duration was 22.4 months and median survival was 25.6 months. Two-year overall, progression-free survival and locoregional control rates were 55.9%, 28.6%, and 56%, respectively. The most common grade 3-4 toxicities were esophagitis (63.6%) and neutropenia (25%). Grade 3-4 postoperative morbidities included surgical wound infection (2.3%), acute renal failure (2.3%), and anastomosis stricture (2.3%).



Trimodality treatment with a high preoperative radiation dose and chemotherapy yielded a good pathologic complete response rate, and long-term survival with low toxicities.
Faculty of Medicine, Department of Radiology, Chulalongkorn University, Bangkok, Thailand.
Chawalit
0000-0002-8868-7462
C
Lertbutsayanukul
Faculty of Medicine, Department of Surgery, Chulalongkorn University, Bangkok, Thailand.
Chadin
C
Tharavej
Faculty of Medicine, Department of Pathology, Chulalongkorn University, Bangkok, Thailand.
Naruemon
N
Klaikeaw
Faculty of Medicine, Department of Radiology, Chulalongkorn University, Bangkok, Thailand.
Anussara
A
Prayongrat
Faculty of Medicine, Department of Radiology, Chulalongkorn University, Bangkok, Thailand.
Chutinan
C
Lowanitchai
Medical Oncology Unit, Faculty of Medicine, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand.
Virote
V
Sriuranpong
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated; D016879:Salvage Therapy

Chemoradiation; esophageal cancer; high-dose radiation therapy; intensity-modulated radiation therapy; trimodality treatment