Simultaneous integrated boost for mediastinal lymph node recurrence after radical surgery for esophageal cancer: Interim results from a phase I/II prospective study

• Published in: Thoracic cancer 2021-04, Vol.12 (8), p.1180-1186
• Main Authors: Qi, Wei‐xiang, Zheng, Siyue, Cao, Lu, Xu, Cheng, Zhao, Shengguang, Chen, Jiayi
• Format: Article
• Language: English
• Subjects: Abdomen; Cancer; Cancer therapies; Chemotherapy; clinical trial; Esophageal cancer; Hematology; Lymphatic system; Medical imaging; Metastasis; Oncology, Experimental; Original; Patients; Planning; Radiation therapy; recurrence; salvage chemoradiotherapy; Surgery; Ultrasonic imaging
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.13891

Background This was a single institute, phase I/II study of salvage chemoradiotherapy (CRT) with simultaneous integrated boost in patients with mediastinal lymph node (LN) recurrence after esophagectomy. Methods Patients who presented with a clinical diagnosis of ≤5 mediastinal LN recurrence received three consecutive levels of radiotherapy dose for the recurrences. Level 1: 58.8 Gy/2.1 Gy/28 fractions, Level 2: 64.4 Gy/2.3 Gy/28 fractions and Level 3: 70 Gy/2.5 Gy/28 fractions. Results A total of 17 patients (10 patients in phase I and 7 patients in phase II) were enrolled in the present study between June 2019 and July 2020. The median duration from surgery to initial recurrence was four months (range: 3–43 months). The most common site of recurrence according to JES was 106recR, accounting for 35%. Dose‐limiting toxicity was not observed during three‐month follow‐up after completion of irradiation. The most common hematological toxicities were leukocytopenia and anemia. The most common nonhematological toxicity was esophagitis. The ORR according to RECIST was 58.8% (CR: seven patients; PR: three patients). With a median follow‐up of 15 months (95% CI: 7–16 months), all patients were still alive. Among them, two patients who received a level 1 dose and one patient who received a level III dose developed multiple lung metastases after salvage CRT, and another patient who received a level 1 dose developed an out‐of‐field recurrence in the left cervical lymph node area. Another patient who received a level III dose developed chest wall recurrence after salvage CRT. Conclusions The regimen of salvage CRT using the simultaneous integrated boost (SIB) technique (70 Gy/2.5 Gy/28F) for mediastinal lymph node recurrence in ESCC patients after esophagectomy is feasible and well tolerated. The prognosis of esophageal squamous cell carcinoma patients who develop recurrence after radical surgery is poor, and there is no established treatment option for this patient population. The present study confirms that a salvage chemoradiotherapy (CRT) regimen with the simultaneous integrated boost (SIB) technique to a maximum dose of 70 Gy/2.5 Gy/28F for mediastinal LN recurrence in ESCC patients after esophagectomy is feasible and well tolerated.