Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer
Background and purpose: The standard treatment for patients with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy (NCRT) plus radical resection. However, the technical aspects for implementing this comprehensive treatment strategy differ, especially in the controversial definition...
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| Format: | Article |
| Language: | English |
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Editorial Office of China Oncology
2023-03-01
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| Series: | Zhongguo aizheng zazhi |
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| Online Access: | http://www.china-oncology.com/fileup/1007-3639/PDF/1681714810843-1225864410.pdf |
| _version_ | 1797840668341567488 |
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| author | DONG Xiaohuan, LIU Jun, LI Hongxuan, CHENG Yan, LI Yue, YU Wen, CAI Xuwei, FU Xiaolong |
| author_facet | DONG Xiaohuan, LIU Jun, LI Hongxuan, CHENG Yan, LI Yue, YU Wen, CAI Xuwei, FU Xiaolong |
| author_sort | DONG Xiaohuan, LIU Jun, LI Hongxuan, CHENG Yan, LI Yue, YU Wen, CAI Xuwei, FU Xiaolong |
| collection | DOAJ |
| description | Background and purpose: The standard treatment for patients with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy (NCRT) plus radical resection. However, the technical aspects for implementing this comprehensive treatment strategy differ, especially in the controversial definition of the radiotherapy target area in NCRT. This study aimed to analyze the feasibility of involving field irradiation (IFI) in NCRT for locally advanced esophageal cancer. Methods: Retrospective analysis of locally advanced esophageal squamous cell carcinoma patients receiving NCRT in Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine from July 2016 to May 2017 showed that the radiotherapy target of all patients was our recommended IFI. The radiotherapy plan was redesigned for the enrolled patients according to the two traditional target delineation of elective node irradiation (ENI) and primary subclinical lesion irradiation (SLI). The dosimetric parameters of the three groups and the dose differences of organ at risk (OAR), such as lungs, heart and spinal cord, were compared, and the relationship between IFI Recurrence pattern and radiation target volumes was analyzed. Results: A total of 26 patients were enrolled. The average target volume of IFI was (277±77) cm3, which was significantly lower compared with ENI and SLI (P<0.05). IFI could significantly reduce relative volume fraction of lungs irradiated more than 5 and 20 Gy (V5 and V20), lungs average dose (Dmean), heart V30, heart Dmean and spinal cord maximum dose (Dmax) (P<0.05), compared with ENI. Lungs V20, lungs Dmean, heart Dmean and spinal cord Dmax decreased by 27.1%, 22.5%, 27.4% and 6.4% compared with ENI, and 24.1%, 22.0%, 24.8% and 5.7% compared with SLI, respectively. After 28 to 69 months of follow-up, 13 patients had recurrence and metastasis, of whom 7 patients had distant metastasis, 4 patients had recurrence in the irradiation field, and 1 patient had local recurrence in the irradiation field. The 3-year overall survival (OS) rate and disease-free survival (DFS) rate were 50.0% and 42.3%, respectively. Conclusion: IFI recommended by our institution is feasible to ensure clinical efficacy while significantly reducing the radiation dose of lungs, heart and spinal cord. |
| first_indexed | 2024-04-09T16:18:30Z |
| format | Article |
| id | doaj.art-b5a6211aa91f4214ba514b93cdfdfeb9 |
| institution | Directory Open Access Journal |
| issn | 1007-3639 |
| language | English |
| last_indexed | 2024-04-09T16:18:30Z |
| publishDate | 2023-03-01 |
| publisher | Editorial Office of China Oncology |
| record_format | Article |
| series | Zhongguo aizheng zazhi |
| spelling | doaj.art-b5a6211aa91f4214ba514b93cdfdfeb92023-04-24T00:08:10ZengEditorial Office of China OncologyZhongguo aizheng zazhi1007-36392023-03-0133326727310.19401/j.cnki.1007-3639.2023.03.010Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancerDONG Xiaohuan, LIU Jun, LI Hongxuan, CHENG Yan, LI Yue, YU Wen, CAI Xuwei, FU Xiaolong01. School of Graduate Studies, Bengbu Medical College, Bengbu 233000, Anhui Province, China;2. Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, ChinaBackground and purpose: The standard treatment for patients with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy (NCRT) plus radical resection. However, the technical aspects for implementing this comprehensive treatment strategy differ, especially in the controversial definition of the radiotherapy target area in NCRT. This study aimed to analyze the feasibility of involving field irradiation (IFI) in NCRT for locally advanced esophageal cancer. Methods: Retrospective analysis of locally advanced esophageal squamous cell carcinoma patients receiving NCRT in Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine from July 2016 to May 2017 showed that the radiotherapy target of all patients was our recommended IFI. The radiotherapy plan was redesigned for the enrolled patients according to the two traditional target delineation of elective node irradiation (ENI) and primary subclinical lesion irradiation (SLI). The dosimetric parameters of the three groups and the dose differences of organ at risk (OAR), such as lungs, heart and spinal cord, were compared, and the relationship between IFI Recurrence pattern and radiation target volumes was analyzed. Results: A total of 26 patients were enrolled. The average target volume of IFI was (277±77) cm3, which was significantly lower compared with ENI and SLI (P<0.05). IFI could significantly reduce relative volume fraction of lungs irradiated more than 5 and 20 Gy (V5 and V20), lungs average dose (Dmean), heart V30, heart Dmean and spinal cord maximum dose (Dmax) (P<0.05), compared with ENI. Lungs V20, lungs Dmean, heart Dmean and spinal cord Dmax decreased by 27.1%, 22.5%, 27.4% and 6.4% compared with ENI, and 24.1%, 22.0%, 24.8% and 5.7% compared with SLI, respectively. After 28 to 69 months of follow-up, 13 patients had recurrence and metastasis, of whom 7 patients had distant metastasis, 4 patients had recurrence in the irradiation field, and 1 patient had local recurrence in the irradiation field. The 3-year overall survival (OS) rate and disease-free survival (DFS) rate were 50.0% and 42.3%, respectively. Conclusion: IFI recommended by our institution is feasible to ensure clinical efficacy while significantly reducing the radiation dose of lungs, heart and spinal cord.http://www.china-oncology.com/fileup/1007-3639/PDF/1681714810843-1225864410.pdf|esophageal squamous carcinoma|neoadjuvant chemoradiotherapy|target volume|organ at risk|dosimetry|recurrence pattern |
| spellingShingle | DONG Xiaohuan, LIU Jun, LI Hongxuan, CHENG Yan, LI Yue, YU Wen, CAI Xuwei, FU Xiaolong Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer Zhongguo aizheng zazhi |esophageal squamous carcinoma|neoadjuvant chemoradiotherapy|target volume|organ at risk|dosimetry|recurrence pattern |
| title | Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer |
| title_full | Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer |
| title_fullStr | Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer |
| title_full_unstemmed | Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer |
| title_short | Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer |
| title_sort | preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer |
| topic | |esophageal squamous carcinoma|neoadjuvant chemoradiotherapy|target volume|organ at risk|dosimetry|recurrence pattern |
| url | http://www.china-oncology.com/fileup/1007-3639/PDF/1681714810843-1225864410.pdf |
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