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Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer

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Abstract

Background

The optimal radiation field of chemoradiation therapy (CRT) for stage I esophageal squamous cell carcinoma (ESCC) is unknown. This retrospective study compared efficacy and safety of two CRT modalities, involved field irradiation (IFI) and elective nodal irradiation (ENI), when treating patients with clinical stage I (T1bN0M0) ESCC.

Methods

Patients had received 60 Gy CRT concurrently with 5-FU and cisplatin between January 2000 and December 2012. The clinical target volume of IFI was limited to the primary tumor plus a 2-cm craniocaudal margin; that of ENI covered the primary tumor plus the field of regional lymph nodes.

Results

One hundred and ninety-five patients were selected (IFI group, 78; ENI group, 117). The 5-year overall, cause-specific and progression-free survival rates were 90.5%, 91.6% and 77.6% in the IFI group, and 72.5%, 88.3%, 57.9% in the ENI group, respectively. Of recurrent patients (n = 16 in the IF and n = 33 in the ENI groups) after achieving complete remission, 12 (75%) in the IFI group received definitive salvage therapy, 11 (33%) patients did in the ENI group. More patients died of diseases other than esophageal cancer in the ENI group (n = 29, 25%) than in the IFI group (n = 3, 3.8%). Multivariate analysis identified ENI (HR 3.63 [1.78–7.38], p < 0.001), age ≥ 70 (HR 2.65 [1.53–4.58], p < 0.001) and PS = 1 (HR 2.36 [1.33–4.18], p = 0.003) as poor prognostic factors for OS.

Conclusions

IF irradiation would be better than ENI for the patients with stage I ESCC who received definitive chemoradiotherapy.

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References

  1. Kitagawa Y, Uno T, Oyama T et al (2018) Esophageal cancer practice guidelines 2017 edited by the japan esophageal society: part 1. Esophagus 1:1–24

    Article  Google Scholar 

  2. Kato H, Sato A, Fukuda H et al (2009) A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan clinical oncology group study. Jpn J Clin Oncol 39(10):638–643. https://doi.org/10.1093/jjco/hyp069

    Article  PubMed  Google Scholar 

  3. Kodama M, Kakegawa T (1998) Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan. Surgery 123:432–439

    Article  CAS  PubMed  Google Scholar 

  4. Ito H, Itasaka S, Sakanaka K et al (2017) Long-term complications of definitive chemoradiotherapy for esophageal cancer using the classical method. J Radiat Res 58(1):106–113

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wang X, Miao C, Chen Z et al (2017) Can involved-field irradiation replace elective nodal irradiation in chemoradiotherapy for esophageal cancer? A systematic review and meta-analysis. Oncol Targets Ther 10(5):2087–2095

    Article  Google Scholar 

  6. Akutsu Y, Kato K, Igaki H et al (2016) The prevalence of overall and initial lymph node metastases in clinical T1N0 thoracic esophageal cancer from the results of JCOG0502, a prospective multicenter study. Ann Surg 264(6):1009–1015

    Article  PubMed  Google Scholar 

  7. Gao XS, Qiao X, Wu F et al (2007) Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma. Int J Radiat Oncol Biol Phys 67(2):389–396

    Article  PubMed  Google Scholar 

  8. Japan Esophageal Society (2017) Japanese classification of esophageal cancer, 11th edition: part II and III. Esophagus 14(1):37–65

    Article  Google Scholar 

  9. Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT0123 (radiation therapy oncology group 94–05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiotherapy. J Clin Oncol 20:1167–1174

    Article  CAS  PubMed  Google Scholar 

  10. Kato K, Nakajima TE, Ito Y et al (2013) Phase II study of concurrent chemoradiotherapy at the dose of 50.4 Gy with elective nodal irradiation for stage II–III esophageal carcinoma. Jpn J Clin Oncol 43(6):608–615

    Article  PubMed  Google Scholar 

  11. Onozawa M, Nihei K, Ishikura S et al (2009) Elective nodal irradiation (ENI) in definitive chemoradiotherapy (CRT) for squamous cell carcinoma of the thoracic esophagus. Radiother Oncol 92:266–269

    Article  CAS  PubMed  Google Scholar 

  12. Kawaguchi Y, Nishiyama K, Miyagi K et al (2011) Patterns of failure associated with involved field radiotherapy in patients with clinical stage I thoracic esophageal cancer. Jpn J Clin Oncol 41(8):1007–1012

    Article  PubMed  Google Scholar 

  13. Ishikawa H, Sakurai H, Tamaki Y et al (2006) Radiation therapy alone for stage I (UICC T1N0M0) squamous cell carcinoma of the esophagus: indications for surgery or combined chemoradiotherapy. J Gastroenterol Hepatol 21(8):1290–1296

    Article  PubMed  Google Scholar 

  14. Fukada J, Shigematsu N, Ohashi T et al (2012) Pericardial and pleural effusions after definitive radiotherapy for esophageal cancer. J Radiat Res 53:447–453

    Article  PubMed  Google Scholar 

  15. Ishikura S, Nihei K, Ohtsu A et al (2003) Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol 21:2697–2702

    Article  CAS  PubMed  Google Scholar 

  16. Mackley HB, Adelstein JS, Reddy CA et al (2008) Choice of radiotherapy planning modality influences toxicity in the treatment of locally advanced esophageal cancer. J Gastrointest Cancer 39(1–4):130–137

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Cancer Center Research and Development Fund (29-A-3). We thank Dr. Nobukazu Hokamura for collecting the data used in this study.

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Authors and Affiliations

  1. Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan

    Yukihiro Nakatani, Ken Kato, Hirokazu Shoji, Satoru Iwasa, Yoshitaka Honma, Atsuo Takashima & Narikazu Boku

  2. Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan

    Toshikazu Ushijima

  3. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Yukihiro Nakatani & Toshikazu Ushijima

  4. Department of Radiology, Showa University School of Medicine, Shinagawa , Tokyo, Japan

    Yoshinori Ito

  5. Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan

    Jun Itami

Authors
  1. Yukihiro Nakatani
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  2. Ken Kato
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  3. Hirokazu Shoji
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  7. Toshikazu Ushijima
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  8. Yoshinori Ito
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  9. Jun Itami
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  10. Narikazu Boku
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Corresponding author

Correspondence to Ken Kato.

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Conflict of interest

Ken Kato received honoraria from Eli Lilly and Beigene; and research funding from ONO, MSD, Merck Serono and Shionogi Co and Ltd. Narikazu Boku received honoraria from Taiho, Chugai, Eli Lilly, Ono and BMS; and research funding from Taiho and Ono. YN, HS, SI, YN, AT, TU, YI and JI report no potential conflicts of interest.

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Nakatani, Y., Kato, K., Shoji, H. et al. Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer. Int J Clin Oncol 25, 1098–1104 (2020). https://doi.org/10.1007/s10147-020-01652-7

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  • DOI: https://doi.org/10.1007/s10147-020-01652-7

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