Preliminary study on involving field irradiation radiotherapy in neoadjuvant chemoradiotherapy for esophageal cancer

doi:10.19401/j.cnki.1007-3639.2023.03.010

Abstract

Abstract:

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 (D_mean), heart V₃₀, heart D_mean and spinal cord maximum dose (D_max) (P<0.05), compared with ENI. Lungs V₂₀, lungs D_mean, heart D_mean and spinal cord D_max 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.

Key words: Esophageal squamous carcinoma, Neoadjuvant chemoradiotherapy, Target volume, Organ at risk, Dosimetry, Recurrence pattern

CLC Number:

R735.1

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[J]. China Oncology, 2023, 33(3): 267-273.

Figures/Tables 5

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References 24

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Characteristic	Value
Age/year median (range)	61 (45-72)
Gender n
Male	22
Female	4
Length/cm median (range)	6 (2-17)
Location n
Upper thoracic	3
Middle thoracic	10
Lower thoracic	13
T stage n
cT₂	1
cT₃	20
cT_4a	5
N stage n
cN₀	5
cN₁	18
cN₂	2
cN₊	1
TNM stage _n
ⅡA	1
ⅡB	2
ⅢA	18
ⅣA	5

Variable	ENI	SLI	IFI	t value		P value
Variable	ENI	SLI	IFI	IFI vs ENI	IFI vs SLI	IFI vs ENI	IFI vs SLI
PTV/cm³	501±128	435±111	277±77	-11.120	-16.934	0.000	0.000
Lung
V₅/%	49±5	48±6	39±5	-13.433	-11.716	0.000	0.000
V₂₀/%	21±3	20±4	15±3	-14.667	-11.012	0.000	0.000
D_mean/cGy	1 042±122	1 038±139	808±126	-13.579	-12.786	0.000	0.000
Heart
V₃₀/%	46±14	42±13	30±16	-10.862	-9.434	0.000	0.000
D_mean/cGy	2 531±489	2 434±427	1 895±735	-8.293	-7.291	0.000	0.000
Spinal cord
D_max/cGy	3 989±342	3 958±326	3 727±313	-6.297	-5.266	0.000	0.000

Variable	IFI-ENI		IFI-SLI		P value
Variable	Media (range)	%	Media (range)	%	P value
Lung
V₅/%	11 (1-18)	-20.8	9 (0-19)	-19.7	0.544
V₂₀/%	6 (1-10)	-27.1	5 (0-12)	-24.1	0.231
D_mean/cGy	260 (7-378)	-22.5	241 (7-441)	-22.0	0.522
Heart
V₃₀/%	15 (0-30)	-36.9	12 (0-29)	-31.9	0.071
D_mean/cGy	624 (27-1 404)	-27.4	484 (3-1 244)	-24.8	0.442
Spinal cord					0.470
D_max/cGy	220 (2-826)	-6.4	154 (4-869)	-5.7

Recurrence	Infield	Outfield	Infield plus outfield	Total
LRR only	2	1	0	3
Distant only	0	7	0	7
LRR plus distant	2	0	1	3
Total	4	8	1	13