Retrospective analysis of outcome differences in preoperative concurrent chemoradiation with or without elective nodal irradiation for esophageal squamous cell carcinoma
Journal
International Journal of Radiation Oncology Biology Physics
Journal Volume
81
Journal Issue
4
Pages
e593-e599
Date Issued
2011
Author(s)
Abstract
Purpose: To evaluate the efficacy and patterns of failure of elective nodal irradiation (ENI) in patients with esophageal squamous cell carcinoma (SCC) undergoing preoperative concurrent chemoradiation (CCRT) followed by radical surgery. Methods and Materials: We retrospectively studied 118 patients with AJCC Stage II to III esophageal SCC undergoing preoperative CCRT (median, 36 Gy), followed by radical esophagectomy. Of them, 73 patients (62%) had ENI and 45 patients (38%) had no ENI. Patients with ENI received radiotherapy to either supraclavicular (n = 54) or celiac (n = 19) lymphatics. Fifty-six patients (57%) received chemotherapy with paclitaxel plus cisplatin. The 3-year progression-free survival, overall survival, and patterns of failure were analyzed. Distant nodal recurrence was classified into M1a and M1b regions. A separate analysis using matched cases was conducted. Results: The median follow-up was 38 months. There were no differences in pathological complete response rate (p = 0.12), perioperative mortality rate (p = 0.48), or delayed Grade 3 or greater cardiopulmonary toxicities (p = 0.44), between the groups. More patients in the non-ENI group had M1a failure than in the ENI group, with 3-year rates of 11% and 3%, respectively (p = 0.05). However, the 3-year isolated distant nodal (M1a + M1b) failure rates were not different (ENI, 10%; non-ENI, 14%; p = 0.29). In multivariate analysis, pathological nodal status was the only independent prognostic factor associated with overall survival (hazard ratio = 1.78, p = 0.045). The 3-year overall survival and progression-free survival were 45% and 45%, respectively, in the ENI group, and 52% and 43%, respectively, in the non-ENI group (p = 0.31 and 0.89, respectively). Matched cases analysis did not show a statistical difference in outcomes between the groups. Conclusions: ENI reduced the M1a failure rate but was not associated with improved outcomes in patients undergoing preoperative CCRT for esophageal SCC. Pathological nodal metastasis predicted poor outcome. ? 2011 Elsevier Inc.
SDGs
Other Subjects
Cis-platin; Complete response; Concurrent chemoradiation; Elective nodal irradiation; Eni groups; Esophageal cancer; Esophageal squamous cell carcinoma; Esophagectomy; Failure rate; Hazard ratio; Mortality rate; Multi variate analysis; Nodal metastasis; Nodal status; Overall survival; Paclitaxel; Patterns of failure; Preoperative chemo-radiation; Prognostic factors; Progression free survival; Radical surgery; Retrospective analysis; Separate analysis; Squamous cell carcinoma; Statistical differences; Chemotherapy; Irradiation; Platinum compounds; Radiotherapy; Multivariant analysis; cisplatin; fluorouracil; paclitaxel; adult; aged; article; cancer radiotherapy; cancer staging; cancer surgery; cancer survival; chemoradiotherapy; clinical effectiveness; continuous infusion; controlled study; esophageal squamous cell carcinoma; female; follow up; heart failure; human; intestine lymph; ischemic heart disease; lymph node irradiation; lymph node metastasis; major clinical study; male; mesentery; pericardial effusion; pleura effusion; preoperative care; preoperative period; priority journal; progression free survival; retrospective study; surgical mortality; treatment failure; treatment response; Adult; Aged; Analysis of Variance; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Chemoradiotherapy; Cisplatin; Disease-Free Survival; Esophageal Neoplasms; Esophagectomy; Female; Fluorouracil; Humans; Lymphatic Irradiation; Male; Middle Aged; Paclitaxel; Preoperative Care; Radiotherapy Dosage; Retrospective Studies; Survival Rate; Treatment Failure
Type
journal article