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

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.

• Authors: Nai-Bin Chen, Bo Qiu, Jun Zhang, Meng-Yun Qiang, Yu-Jia Zhu, Bin Wang, Jin-Yu Guo, Ling-Zhi Cai, Shao-Min Huang, Meng-Zhong Liu, Qun Li, Yong-Hong Hu, Qi-Wen Li, Hui Liu
• Journal: Cancer research and treatment (Cancer Res Treat) Vol. 52 Issue 1 Pg. 31-40 (Jan 2020) ISSN: 2005-9256 [Electronic] Korea (South)
• PMID: 31048664 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Chemoradiotherapy
• Combined Modality Therapy
• Esophageal Squamous Cell Carcinoma (diagnosis, mortality, therapy)
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• Radiotherapy Dosage
• Radiotherapy, Conformal (adverse effects, methods)
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Survival Analysis
• Treatment Outcome