Long-term results of chemoradiotherapy with elective nodal irradiation for resectable locally advanced esophageal cancer in three-dimensional planning system

• Published in: International journal of clinical oncology 2023-03, Vol.28 (3), p.382-391
• Main Authors: Miyoshi, Shota, Nishibuchi, Ikuno, Murakami, Yuji, Katsuta, Tsuyoshi, Imano, Nobuki, Hirokawa, Junichi, Hamai, Yoichi, Emi, Manabu, Okada, Morihito, Nagata, Yasushi
• Format: Article
• Language: English
• Subjects: 5-Fluorouracil; Adverse events; Aged; Aged, 80 and over; Cancer Research; Cardiovascular diseases; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Clavicle; Congestive heart failure; Esophageal cancer; Esophageal carcinoma; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - radiotherapy; Esophageal Squamous Cell Carcinoma - drug therapy; Esophageal Squamous Cell Carcinoma - radiotherapy; Fluorouracil - therapeutic use; Humans; Lymph nodes; Medicine; Medicine & Public Health; Metastases; Middle Aged; Oncology; Original Article; Radiation therapy; Retrospective Studies; Squamous cell carcinoma; Surgical Oncology
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-023-02290-5

Background We evaluated the long-term results of definitive chemoradiotherapy (CRT) with elective nodal irradiation (ENI) using a three-dimensional (3D) planning system for resectable, locally advanced esophageal squamous cell carcinoma (LA-ESCC). Methods This retrospective study included 65 patients with LA-ESCC who started CRT between 2006 and 2017. Patients with Stage I–IV LA-ESCC according to the Union for International Cancer Control TNM classification (eighth edition) were included. In stage IV, only supraclavicular lymph node (LN) metastasis was included. All patients received radiotherapy with ENI and concurrent chemotherapy with platinum and 5-fluorouracil. Results The median age of the patients was 70 years (range 52–83 years). Stage I, II, III, and IV diseases were observed in 3 (5%), 28 (43%), 22 (34%), and 12 patients (18%), respectively. The median prescription dose was 66 Gy (range 50.4–66 Gy). The median follow-up period for the survivors was 71 months (range 8–175 months). The 5-year overall survival (OS) and progression-free survival rates were 54 and 43%, respectively. The 5-year OS rates for stages I–II and III–IV were 67 and 42%, respectively. Recurrence occurred in 29 patients (45%), and recurrence of regional LNs only occurred in 2 patients (3%). Grade 3 or higher late adverse events were observed in 8 patients (12%). Grade 5 heart failure occurred in two patients (3%); both had cardiovascular disease before treatment. Conclusion The long-term results of definitive CRT with ENI for resectable LA-ESCC were favorable. ENI with a 3D planning system may reduce regional LN recurrence and late adverse events.