scholarly journals Cardiac radiation dose predicts survival in esophageal squamous cell carcinoma treated by definitive concurrent chemotherapy and intensity modulated radiotherapy

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Tzu-Hui Pao ◽  
Wei-Lun Chang ◽  
Nai-Jung Chiang ◽  
Jeffrey Shu-Ming Chang ◽  
Chia-Ying Lin ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Radiation Dose ◽  
Adverse Events ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cumulative Incidence ◽  
Prognostic Significance ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Dose Volume ◽  
Cardiac Dose

Abstract Background The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) remains largely unknown. We aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal squamous cell carcinoma (ESCC) after definitive CCRT. Methods One hundred and twenty-one ESCC patients undergoing definitive CCRT with intensity modulated radiotherapy technique between 2008 and 2018 were reviewed. Cardiac dose-volume parameters were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis. Results Median follow-up was 16.2 months (range, 4.3–109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). Patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03). Conclusions Cardiac radiation dose inversely correlated with survival in ESCC after definitive CCRT. Radiation dose to the heart should be minimized.

scholarly journals Cardiac radiation dose predicts survival in esophageal squamous cell carcinoma treated by definitive concurrent chemotherapy and intensity modulated radiotherapy

2020 ◽  
Author(s):  
Tzu-Hui Pao ◽  
Wei-Lun Chang ◽  
Nai-Jung Chiang ◽  
Jeffrey Shu-Ming Chang ◽  
Chia-Ying Lin ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Radiation Dose ◽  
Adverse Events ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cumulative Incidence ◽  
Prognostic Significance ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Dose Volume ◽  
Cardiac Dose

Abstract Background: The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) remains largely unknown. We aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal squamous cell carcinoma (ESCC) after definitive CCRT. Methods: One hundred and twenty-one ESCC patients undergoing definitive CCRT with intensity modulated radiotherapy technique between 2008 and 2018 were reviewed. Cardiac dose-volume parameters were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis. Results: Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). Patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03). Conclusions: Cardiac radiation dose inversely correlated with survival in ESCC after definitive CCRT. Radiation dose to the heart should be minimized.

scholarly journals Cardiac radiation dose predicts survival in esophageal cancer treated by definitive concurrent chemoradiotherapy

2020 ◽  
Author(s):  
Tzu-Hui Pao ◽  
Wei-Lun Chang ◽  
Nai-Jung Chiang ◽  
Jeffrey Shu-Ming Chang ◽  
Chia-Ying Lin ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Dose ◽  
Adverse Events ◽  
Cumulative Incidence ◽  
Concurrent Chemoradiotherapy ◽  
Prognostic Significance ◽  
Rank Test ◽  
Dose Volume ◽  
Cardiac Dose ◽  
Cardiac Adverse Events

Abstract Background The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) without surgery remains largely unknown. This study aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal cancer after definitive CCRT. Methods A total of 121 consecutive esophageal cancer patients undergoing definitive CCRT between 2008 and 2018 were reviewed. Dose-volume parameters of the heart were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis. Results Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. The median heart V5, V10, and V20 were 94.3%, 86.4%, and 76.9%, respectively. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Moreover, lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). The patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03). Conclusions Cardiac radiation dose was inversely correlated with survival in esophageal cancer treated by definitive CCRT. Radiation dose to the heart should be minimized.

scholarly journals Intensity-modulated radiotherapy with more than 60 Gy improved the survival of inoperable patients with locally advanced esophageal squamous cell carcinoma: a population-based real-world study

2021 ◽  
Author(s):  
Wei Zhang ◽  
Jing Yu ◽  
Jing Hu ◽  
Jie Li ◽  
Wen Ouyang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Retrospective Study ◽  
Radiation Dose ◽  
Esophageal Squamous Cell Carcinoma ◽  
Dose Group ◽  
Low Dose ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
High Dose ◽  
Intensity Modulated

Abstract Background Intensity-modulated radiotherapy (IMRT) is widely applied during the treatment of esophageal squamous cell carcinoma (ESCC), but the optimal radiation dose still lacks a consensus. The aim of this study was to explore the optimal radiation dose for inoperable locally advanced ESCC patients treated with IMRT in a real-world clinical setting. Methods A total of 90 inoperable ESCC patients with locally advanced stages of Ⅱ-IVA treated with IMRT in our institute between February 1, 2014 and June 30, 2019 were included in this retrospective study. Sixty patients had received > 60 Gy (high dose group) and 30 patients had received ≤ 60 Gy (low dose group). The median radiation dose was 66 Gy (range: 61–70 Gy) and 50.2 Gy (range: 40–60 Gy), respectively. Concurrent chemotherapies were platinum-based regimens. Results The median progression free survival (PFS) and overall survival (OS) of all patients were 7.6 and 14.1 months, respectively. Patients in the high dose group exhibited a significantly better PFS (1-year PFS 34.6% vs 22.8%; 2-year PFS 11.9% vs 0%, P = 0.008) and OS (1-year OS 57.5% vs 39.5%; 2-year OS 31.4% vs 15.8%, P = 0.007). The median PFS in the high and low dose groups were 8.1 and 6.1 months, and the median OS were 15.4 and 8.5 months, respectively. Multivariate Cox analysis showed that radiation dose (> 60 Gy vs ≤ 60 Gy) was independently prognostic factor for OS (HR: 0.44; 95% CI: 0.22–0.89; P = 0.021), but not for PFS (HR: 0.56; 95% CI: 0.31–1.02; P = 0.058). There was no significant difference in treatment-related toxicities of grade ≥ 3 between the 2 groups (P = 0.402). Conclusion This retrospective study confirmed that higher radiation dose (> 60 Gy) resulted in better survival outcomes for inoperable patients with locally advanced ESCC treated with IMRT.

scholarly journals Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma without hypopharyngeal invasion: dose distribution and clinical outcome

2019 ◽  
Vol 60 (4) ◽  
pp. 517-526 ◽  
Author(s):  
Yuichi Ishida ◽  
Katsuyuki Sakanaka ◽  
Kota Fujii ◽  
Satoshi Itasaka ◽  
Takashi Mizowaki
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Initial Recurrence ◽  
Upper Cervical

AbstractHypopharyngeal invasion would be a key finding in determining the extent of the irradiation fields in patients with cervical esophageal squamous cell carcinoma (CESCC). This study aimed to investigate the clinical outcomes of chemoradiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) omitting upper cervical lymph nodal irradiation in CESCC without hypopharyngeal invasion, and the dosimetric superiority of SIB-IMRT to 3D conformal radiotherapy (3DCRT). We retrospectively identified 21 CESCC patients without hypopharyngeal invasion [clinical Stage I/II/III/IV (M1LYM); 3/6/5/7] (UICC-TNM 7th edition) who underwent chemoradiotherapy using SIB-IMRT between 2009 and 2015. SIB-IMRT delivered 60 Gy to each primary tumor and the metastatic lymph nodes, and 48 Gy to elective lymph nodal regions, including Levels III and IV of the neck, supraclavicular, and upper mediastinal lymphatic regions, in 30 fractions. The overall survival rate, locoregional control rate, and initial recurrence site were evaluated. 3DCRT plans were created to perform dosimetric comparisons with SIB-IMRT. At a median follow-up of 64.5 months, the 5-year locoregional control and overall survival rates were 66.7% and 53.4%, respectively. Disease progressed in eight patients: all were locoregional progressions and no patients developed distant progression including upper cervical lymph nodal regions as initial recurrence sites. The planning study showed SIB-IMRT improved target coverage without compromising the dose to the organs at risk, compared with 3DCRT. In conclusion, omitting the elective nodal irradiation of the upper cervical lymph nodes was probably reasonable for CESCC patients without hypopharyngeal invasion. Locoregional progression remained the major progression site in this population.

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