Efficacy Analysis Of Intensity Modulated Radiotherapy With Or Without Simultaneous Integrated Boost ± Concurrent Chemotherapy For Esophageal Cancer

Part ?Title:Analysis of the efficacy and prognostic factors of 1 637 esophageal cancer patients treated with intensity-modulated radiotherapyPurpose:To summarize survival outcomes and prognostic factors in esophageal cancer(EC)patients treated with intensity-modulated radiotherapy(IMRT).Materials and methods:A retrospective analysis was performed on 1 637 patients with esophageal cancer who were admitted to our hospital from January 2005 to December 2017 and met the inclusion criteria.Overall survival(OS),progression-free survival(PFS)and pattern of recurrence were analyzed.The Kaplan-Meier method was used to calculate survival rates,log-rank test was used to detect survival difference and for univariate analysis,Cox method for multivariate analysis.Results:Median follow-up time was 49.8 months.1-year,3-year and 5-year OS and PFS of the entire group were 65.9%and 45.8%,34.2%and 25.0%,27.0%and 18.5%,respectively.Univariate analysis showed that sex,KPS,tumor location,T stage,N stage,M stage,TNM stage,radiation dose and treatment modality were prognostic factors for OS and PFS(P<0.01).Multivariate analysis indicated that sex,KPS,TNM stage,radiation dose and treatment modality were prognostic factors for OS and PFS(P<0.01).Conclusion:Esophageal cancer treated with IMRT can obtain a promising survival.Sex,KPS,TNM stage,radiation dose and treatment modality are prognostic factors for survival results.Part ?Title:A phase ?/? radiation dose escalation trial using simultaneous integrated boost technique with elective nodal irradiation and concurrent chemotherapy for unresectable esophageal cancerPurpose:To investigate the safety and tolerability of simultaneous integrated boost(SIB)technique concurrent with elective nodal irradiation(ENI)and dual-drug chemotherapy for patients with unresectable esophageal cancer.Materials and methods:In phase I,the prophylactic PTV received a stable dose of 50.40 Gy/1.80 Gy/28f while the boost area was planned with 3 consecutive dose levels:the first dose level was 60.76 Gy/2.17 Gy/28f,and then escalated approximately every 2 Gy.ENI was incorporated in Clinical Target Volume(CTV),and paclitaxel and nedaplatin were given concurrently for at least 5 weeks.In phase?,enrolled patients were treated with Maximum Tolerated Dose(MTD)obtained in phase ? and the compliance rate,survival results and toxicities were evaluated.Results:From December 2014 to April 2017,53 patients were enrolled.In phase I,2 out of 6 patients developed Dose-Limiting Toxicity(DLT)at dose level 1.Due to excessive treatment-related toxicities,the escalation process was suspended and de-escalated to 59.92 Gy/2.14 Gy/28f.Three patients were treated at this dose level,all of whom completed at least 5 weeks of chemotherapy and none of whom reached a DLT,determining the newly added dose level to be the MTD.In phase ?,44 patients were treated with MTD,31 of them(70.0%)completed at least 5 weeks of chemotherapy.The most common Grade 3 or 4 toxicities in phase ?included leukopenia(21%)and esophagitis(15%).With a median follow-up time of 16.9 months,1-y OS,DFS and local-control rates were 78.3,57.3 and 77.1%respectively.Conclusion:The SIB technique was feasible and safe at the MTD(95%PGTV/PTV 59.92 Gy/50.40 Gy/28f)concurrent with ENI and dual-drug chemotherapy for patients with unresectable esophageal cancer.Part ?Title:Definitive simultaneous integrated boost versus conventional fractionated intensity modulated radiotherapy for patients with advanced esophageal squamous cell carcinoma:a propensity score-matched analysisPurpose:The aim of this study was to compare the effects of simultaneous integrated boost-intensity modulated radiotherapy(SIB-IMRT)and conventional fractionated-IMRT(CF-IMRT)in definitive radiotherapy of esophageal squamous cell carcinoma(ESCC).Materials and methods:The data of 1 173 patients treated with either CF-IMRT or SIB-IMRT for a curative intent from 2005 to 2016 were retrospectively reviewed.Propensity score matching(PSM)was used to create a well-balanced cohort of 687 patients at 1:2 ratio(237 patients in SIB-IMRT group and 450 patients in CF-IMRT group).Overall survival(OS),progression-free survival(PFS),recurrence pattern,and toxicity profiles were evaluated and compared between the two groups after PSM.Results:After a median follow-up time of 42.3 months(range,3.0-153.2 months)for surviving patients,survival results were comparable in the two groups.After PSM,the 1-year,2-year and 4-year OS rates in the SIB-IMRT and CF-IMRT groups were 70.0%vs.66.4%,41.9%vs.41.7%and 30.2%vs.27.6%,respectively(P=0.87).The 1-year,2-year and 4-year PFS rates were 48.4%vs.49.1%,31.2%vs.29.4%,and 26.1%vs.17.9%,respectively(P=0.64).Locoregional recurrence(P=0.32)and distant metastasis(P=0.54)rates were also comparable between two groups.The toxicity profile was similar in the two groups.Multivariate analyses in the matched samples showed that female,earlier clinical stage,concurrent chemotherapy and EDQ2?60 Gy were independently associated with longer OS and PFS.Conclusion:SIB-IMRT appears to be equivalent to CF-IMRT in treatment efficacy and safety,and could become an alternative option for definitive radiotherapy of ESCC.Part ?Title:Concurrent chemoradiotherapy versus radiation monotherapy for patients with esophageal squamous cell carcinoma in the era of intensity modulated radiotherapy:a propensity score-matched analysisPurpose:To investigate the survival benefit of concurrent chemoradiotherapy for patients with locally advanced esophageal squamous cell carcinoma(ESCC)during the years of intensity-modulated radiotherapy(IMRT).Materials and methods:Medical records of 1 273 patients with ESCC who received IMRT from January 2005 to December 2017 were retrospectively reviewed.683 patients received concurrent chemoradiotherapy(CCRT),590 patients received radiotherapy alone.Propensity score matching(PSM)method was used to eliminate baseline differences between the two groups.Survival and toxicity profile were evaluated afterwards.Results:After a median follow-up time of 50.4 months(3.2-157.4 months),both overall survival(OS)and progression-free survival(PFS)of the CCRT group were better than those of the radiotherapy group,either before or after PSM.After PSM,the 1-,3-,5-year OS of radiotherapy and CCRT groups were 63.3%vs 72.2%,31.6%vs 42.2%and 28.5%vs 38.1%,respectively(P=0.003).The 1-,3-,5-year PFS were 44.3%vs 48.6%,23.4%vs 31.2%and 15.8%vs 25.2%,respectively(P=0.02).The rates of ?grade 3 leukopenia and radiation esophagitis in the CCRT group were higher than that of radiotherapy alone group(P<0.05).There was no significant difference in the probability of radiation pneumonia between the two groups(P=0.359).Multivariate Cox analysis indicated that female,stage ?-?,EQD2?60 Gy and concurrent chemotherapy were favorable prognostic factors for both OS and PFS.Conclusion:Concurrent chemotherapy can bring survival benefits to patients with locally advanced ESCC receiving IMRT.For patients who cannot tolerate concurrent chemotherapy,radiation monotherapy is an effective alternative with promising results.