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Radiother Oncol. 2017 Oct;125(1):73-79. doi: 10.1016/j.radonc.2017.08.025. Epub 2017 Sep 17.

Dose escalation intensity-modulated radiotherapy-based concurrent chemoradiotherapy is effective for advanced-stage thoracic esophageal squamous cell carcinoma.

Author information

1
Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taiwan.
2
Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei, Taiwan.
3
Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taiwan.
4
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taiwan.
5
Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taiwan.
6
Ph.D. Program for Translational Medicine, Taipei Medical University, Taiwan.
7
Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taiwan. Electronic address: szuyuanwu5399@gmail.com.

Abstract

PURPOSE:

No studies have investigated the effects of irradiation-dose escalation intensity-modulated radiotherapy (IMRT)-based concurrent chemoradiotherapy (CCRT) in patients with thoracic esophageal squamous cell carcinoma (TESCC).

PATIENTS AND METHODS:

We analyzed data from patients with TESCC who were enrolled in the Taiwan Cancer Registry database. To compare treatment outcomes, the patients were categorized into two groups according to their radiotherapy doses: group 1, who received CCRT<60Gy with IMRT, and group 2, who received CCRT≥60Gy with IMRT. Group 1 was used as the control for investigating posttreatment mortality risk.

RESULTS:

We enrolled 2061 patients with TESCC without distant metastasis who received CCRT with IMRT. Multivariate Cox regression analysis indicated that advanced clinical American Joint Committee on Cancer (AJCC) stage (≥IIIA), alcohol consumption, and cigarette smoking were significant, poor independent predictors in patients with TESCC receiving IMRT-based CCRT. IMRT-based CCRT (≥60Gy; adjusted hazard ratio [aHR]: 0.75; 95% confidence interval [CI]: 0.63-0.83) was a significant independent prognostic factor for overall survival (P<0.0001). After adjustment for confounders, the aHRs (95% CIs) for overall mortality at all clinical stages were 0.75 (0.68-0.83, P<0.0001) in group 2. In group 2, the aHRs (95% CIs) for overall mortality at early (IA-IIB) and advanced (IIIA-IIIC) AJCC clinical stages were 0.89 (0.70-1.04, P=0.1905) and 0.75 (0.67-0.83, P<0.0001), respectively.

CONCLUSION:

Compared with standard-dose IMRT-based CCRT, high-dose IMRT-based CCRT yields more favorable survival outcomes in patients with advanced-stage TESCC.

KEYWORDS:

Dose escalation; Intensity-modulated radiotherapy; Squamous cell carcinoma; Thoracic esophageal cancer

PMID:
28923576
DOI:
10.1016/j.radonc.2017.08.025
[Indexed for MEDLINE]

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