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Cancer Res Treat. 2019 Apr 30. doi: 10.4143/crt.2018.624. [Epub ahead of print]

Intensity-Modulated Radiotherapy versus Three-Dimensional Conformal Radiotherapy in Definitive Chemoradiotherapy for Cervical Esophageal Squamous Cell Carcinoma: Comparison of Survival Outcomes and Toxicities.

Chen NB1,2,3, Qiu B1,2,3, Zhang J1,2,3, Qiang MY1,2,3, Zhu YJ1,2,3, Wang B1,2,3, Guo JY1,2,3, Cai LZ1,2,3, Huang SM1,2,3, Liu MZ1,2,3, Li Q1,2,3, Hu YH1,2,3, Li QW1,2,3, Liu H1,2,3.

Author information

1
Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
2
State Key Laboratory of Oncology in South China, Guangzhou, China.
3
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.

Abstract

Purpose:

The purpose of this study was to compare the survival and toxicities in cervical esophageal squamous cell carcinoma (CESCC) treated by concurrent chemoradiothrapy with either three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) techniques.

Materials and Methods:

A total of 112 consecutive CESCC patients were retrospectively reviewed. 3D-CRT and IMRT groups had been analyzed by propensity score matching method, with sex, age, Karnofsky performance status, induction chemotherapy and tumor stage well matched. The Kaplan-Meier method and Cox proportional hazards model were used for overall survival (OS) and progression-free survival (PFS). Toxicities were compared between two groups by Fisher exact test.

Results:

With a median follow-up time of 34.9 months, the 3-year OS (p=0.927) and PFS (p=0.859) rate was 49.6% and 45.8% in 3D-CRT group, compared with 54.4% and 42.8% in IMRT group. The rates of grade≥3 esophagitis, grade≥2 pneumonitis, esophageal stricture and hemorrhage were comparable between two groups, while the rate of tracheostomy dependence was much higher in IMRT group than 3D-CRT group (14.3% vs.1.8%, p=0.032). Radiotherapy technique (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.01 to 0.79) and pretreatment hoarseness (HR, 0.12; 95% CI 0.02 to 0.70) were independently prognostic of tracheostomy dependence.

Conclusion:

No survival benefits had been observed while comparing IMRT versus 3D-CRT in CESCC patients. IMRT with fraction dose escalation and pretreatment hoarseness were considered to be associated with a higher risk for tracheostomy dependence. Radiation dose escalation beyond 60 Gy should be taken into account carefully when using IMRT with hypofractionated regimen.

KEYWORDS:

Cervical esophageal squamous cell carcinoma; Conformal radiotherapy; Intensity-modulated radiotherapy; Survival; Tracheostomy dependence

PMID:
31048664
DOI:
10.4143/crt.2018.624
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