Simultaneous integrated boost concepts in definitive radiation therapy for esophageal cancer: outcomes and toxicity

Abstract Background Radiation therapy and chemoradiation therapy play a major role in the definitive management of esophageal cancer. Survival in esophageal cancer patients is still relatively poor, mostly due to high rates of local recurrence and distant metastases. It is hypothesized that dose escalation in radiotherapy could improve outcomes. Therefore, this retrospective analysis aimed to investigate the outcomes and toxicity in patients treated with local dose escalation by means of using simultaneous integrated boost concepts. Methods Between 2012 and 2018, 101 patients with esophageal carcinoma were analyzed in this monocentric, retrospective study. All patients received definitive chemoradiation or radiation therapy alone as intensity modulated radiotherapy. The prescribed dose was 50.4 Gy in 28 fractions to the primary tumor and the elective lymph nodes as well as a simultaneous integrated boost (SIB) with 58.8 Gy to macroscopic tumor and lymph node metastases. Endpoints were overall survival (OS), progression free survival (PFS), local control rate (LCR) and toxicity. Results 60 patients (59.4%) received chemoradiation, 41 patients (40.6%) radiotherapy alone. The median follow up was 17 months (range 0–75 months). OS, PFS and LCR were at 63.9%, 53.9% and 59.9% after 1 year and 37.6%, 34.5% and 36.1%, respectively after 3 years. 16 patients (15.8%) in total developed a locoregional recurrence within the field of radiation. In 48 patients (47.5%) at least one grade III° (CTCAE) toxicity was documented during radiotherapy, mostly dysphagia (36 pat., 75%). One patient suffered from a grade IV° pneumonia. Conclusion This retrospective analysis demonstrates that a SIB concept in definitive (chemo)radiation therapy is safe and feasible, showing acceptable outcomes in this patient cohort. Considering that this cohort mainly consists of elderly patients not eligible for chemotherapy in many cases, we emphasize the aspect of SIB radiation therapy as potential partial compensation for omitted simultaneous chemotherapy. Prospective studies are needed for validation.

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Different definitions of esophagus influence esophageal toxicity prediction for esophageal cancer patients administered simultaneous integrated boost versus standard-dose radiation therapy

Scientific Reports ◽

10.1038/s41598-017-00168-x ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Bao-tian Huang ◽

Rui-hong Huang ◽

Wu-zhe Zhang ◽

Wen Lin ◽

Long-jia Guo ◽

...

Keyword(s):

Esophageal Cancer ◽

Radiation Therapy ◽

Cancer Patients ◽

Standard Dose ◽

Simultaneous Integrated Boost ◽

Toxicity Prediction ◽

Integrated Boost ◽

Dose Radiation

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A phase I/II radiation dose escalation trial using simultaneous integrated boost technique with elective nodal irradiation and concurrent chemotherapy for unresectable esophageal Cancer

Radiation Oncology ◽

10.1186/s13014-019-1249-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 5

Author(s):

Chen Li ◽

Wenjie Ni ◽

Xin Wang ◽

Zongmei Zhou ◽

Wei Deng ◽

...

Keyword(s):

Esophageal Cancer ◽

Radiation Dose ◽

Phase I ◽

Dose Escalation ◽

Concurrent Chemotherapy ◽

Simultaneous Integrated Boost ◽

Elective Nodal Irradiation ◽

Integrated Boost

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Dosimetric and radiobiological comparison of external beam radiotherapy using simultaneous integrated boost technique for esophageal cancer in different location.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15505 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15505-e15505

Author(s):

Lu Wang ◽

Jinming Yu

Keyword(s):

Esophageal Cancer ◽

External Beam Radiotherapy ◽

Intensity Modulated Radiotherapy ◽

Target Volume ◽

Simultaneous Integrated Boost ◽

Conformity Index ◽

Tumor Control ◽

Tumor Control Probability ◽

Integrated Boost ◽

Treatment Plans

e15505 Background: Based on dosimetry and radiobiology to compare treatment plans for esophageal cancer (EC) in different location using intensity modulated radiotherapy (IMRT), volumetric modulated arc radiotherapy (VMAT) and helical tomotherapy(HT) with simultaneous integrated boost (SIB) technique. Methods: A total of 20 patients including 5 cases respectively located in the cervix, upper, middle and lower thorax were generated for IMRT, VMAT and HT plans. The dose volume histogram statistics, conformity index (CI), homogeneity index (HI), tumor control probability (TCP) and normal tissues control probability (NTCP) were analyzed to evaluate treatment plans. Results: HT showed significantly improvement over IMRT and VMAT in terms of CI(0.93±0.03), HI(0.07±0.03) and TCP(88.08±0.82%) in cervical EC(p<0.05). IMRT greatly developed TCP(88.29±1.79%;85.11±0.79%), and offered superior CIs (0.87±0.04;0.90±0.01) and HIs(0.10±0.01; 0.06±0.01) compared with VMAT and HT in upper and middle thoracic EC(p<0.05). Meanwhile, the V30(33.30±6.49%), mean dose (2559.00±219.64cGy) and NTCP(0.50±0.61%) of heart for IMRT were significantly reduced than other two techniques in middle thoracic EC. Patients with lower thoracic EC yielded the similar CIs and HIs(all p>0.05) for the 3 techniques, but VMAT showed the lowest NTCP of lungs (0.01±0.01%) with improved TCP (84.84±1.13%). Conclusions: HT was a good option with little lung and heart involvement as it achieved superior dose conformality and uniformity. IMRT was a perfect strategy with large thoracic involvement. It significantly improved tumor local control and reduced heart dose and complications with acceptable dose to lungs. VMAT was preferred with a smaller target volume but surrounded by more heart and less lungs. Individually choosing optimal technique for EC in different location will be warranted.

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