Dose-Response Relationship between Radiation Dose and Loco-regional Control in Patients with Stage II-III Esophageal Cancer Treated with Definitive Chemoradiotherapy
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Purpose The correlation between radiation dose and loco-regional control (LRC) was evaluated in patients with stage II-III esophageal cancer treated with definitive concurrent chemoradiotherapy (CRT). Materials and Methods Medical records of 236 stage II-III esophageal cancer patients treated with definitive CRT at Yonsei Cancer Center between 1994 and 2013 were retrospectively reviewed. Among these, 120 received a radiation dose of < 60 Gy (standard-dose group), while 116 received ! 60 Gy (high-dose group). The median doses of radiation in the standard- and high-dose groups were 50.4 and 63 Gy, respectively. Concurrent 5-fluorouracil/cisplatin chemotherapy was administered to most patients. Results There were no differences in patient characteristics between the two groups except for high Karnofsky performance status and lower-thoracic lesions being more prevalent in the standard- dose group. The median progression-free survival (PFS) and overall survival (OS) times were 13.2 months and 26.2 months, respectively. Patients in the high-dose group had significantly better 2-year LRC (69.1% vs. 50.3%, p=0.002), median PFS (16.7 months vs. 11.7 months, p=0.029), and median OS (35.1 months vs. 22.3 months, p=0.043). Additionally, LRC exhibited a dose-response relationship and the complete response rate was significantly higher in the high-dose group (p=0.006). There were no significant differences in treatment-related toxicities between the groups. Conclusion A higher radiation dose (> 60 Gy) is associated with increased LRC, PFS, and OS in patients with stage II-III esophageal cancer treated with definitive CRT.
Abstract
Purpose The correlation between radiation dose and loco-regional control (LRC) was evaluated in patients with stage II-III esophageal cancer treated with definitive concurrent chemoradiotherapy (CRT). Materials and Methods Medical records of 236 stage II-III esophageal cancer patients treated with definitive CRT at Yonsei Cancer Center between 1994 and 2013 were retrospectively reviewed. Among these, 120 received a radiation dose of < 60 Gy (standard-dose group), while 116 received ! 60 Gy (high-dose group). The median doses of radiation in the standard- and high-dose groups were 50.4 and 63 Gy, respectively. Concurrent 5-fluorouracil/cisplatin chemotherapy was administered to most patients. Results There were no differences in patient characteristics between the two groups except for high Karnofsky performance status and lower-thoracic lesions being more prevalent in the standard- dose group. The median progression-free survival (PFS) and overall survival (OS) times were 13.2 months and 26.2 months, respectively. Patients in the high-dose group had significantly better 2-year LRC (69.1% vs. 50.3%, p=0.002), median PFS (16.7 months vs. 11.7 months, p=0.029), and median OS (35.1 months vs. 22.3 months, p=0.043). Additionally, LRC exhibited a dose-response relationship and the complete response rate was significantly higher in the high-dose group (p=0.006). There were no significant differences in treatment-related toxicities between the groups. Conclusion A higher radiation dose (> 60 Gy) is associated with increased LRC, PFS, and OS in patients with stage II-III esophageal cancer treated with definitive CRT.
참고문헌 (23)
- Global Burden of Disease Cancer Collaboration, "The global burden of cancer 2013", JAMA Oncol, 1, pp.505~527 (2015)
- Enzinger PC, "Esophageal cancer", N Engl J Med, 349, pp.2241~2252 (2003)
- Bosset JF, "Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus", N Engl J Med, 337, pp.161~167 (1997)
- Tepper J, "Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer : CALGB 9781", J Clin Oncol, 26, pp.1086~1092 (2008)
- Cooper JS, "Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group", JAMA, 281, pp.1623~1627 (1999)
- al-Sarraf M, "Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer : an intergroup study", J Clin Oncol, 15, pp.277~284 (1997)
- Herskovic A, "Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus", N Engl J Med, 326, pp.1593~1598 (1992)
- Minsky BD, "INT 0123(Radiation Therapy Oncology Group 94-05)phase III trial of combined-modality therapy for esophageal cancer : high-dose versus standard-dose radiation therapy", J Clin Oncol, 20, pp.1167~1174 (2002)
- Kachnic LA, "Longitudinal quality-of-life analysis of RTOG 94-05(Int 0123) : a phase III trial of definitive chemoradiotherapy for esophageal cancer", Gastrointest Cancer Res, 4, pp.45~52 (2011)
- "NCCN guideline" (2016)[URL]
- Fletcher GH, "Keynote address : the scientific basis of the present and future practice of clinical radiotherapy", Int J Radiat Oncol Biol Phys, 9, pp.1073~1082 (1983)
- Halperin EC, "Perez and Brady's principles and practice of radiation oncology" (2013), Lippincott Williams & Wilkins
- Seung SK, "Selective dose escalation of chemoradiotherapy for esophageal cancer: role of treatment intensification", Semin Oncol, 31(6 Suppl 18), pp.13~19 (2004)
- Zhang Z, "Doseresponse relationship in locoregional control for patients with stage II-III esophageal cancer treated with concurrent chemotherapy and radiotherapy", Int J Radiat Oncol Biol Phys, 61, pp.656~664 (2005)
- Song T, "High-dose versus conventional-dose irradiation in cisplatin-based definitive concurrent chemoradiotherapy for esophageal cancer : a systematic review and pooled analysis", Expert Rev Anticancer Ther, 15, pp.1157~1169 (2015)
- Suh YG, "Highdose versus standard-dose radiotherapy with concurrent chemotherapy in stages II-III esophageal cancer", Jpn J Clin Oncol, 44, pp.534~540 (2014)
- Sasamoto R, "Long-term results of chemoradiotherapy for locally advanced esophageal cancer, using daily low-dose 5-fluorouracil and cis-diammine-dichloro-platinum(CDDP)", Int J Clin Oncol, 12, pp.25~30 (2007)
- Bedenne L, "Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus : FFCD 9102", J Clin Oncol, 25, pp.1160~1168 (2007)
- Vincent J, "Early surgery for failure after chemoradiation in operable thoracic oesophageal cancer : analysis of the non-randomised patients in FFCD 9102 phase III trial : Chemoradiation followed by surgery versus chemoradiation alone", Eur J Cancer, 51, pp.1683~1693 (2015)
- Hurmuzlu M, "High-dose definitive concomitant chemoradiotherapy in non-metastatic locally advanced esophageal cancer : toxicity and outcome", Dis Esophagus, 23, pp.244~252 (2010)
- Darby SC, "Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer : prospective cohort study of about 300, 000women in US SEER cancer registries", Lancet Oncol, 6, pp.557~565 (2005)
- Bradley JD, "Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer(RTOG 0617) : a randomised, two-by-two factorial phase 3 study", Lancet Oncol, 16, pp.187~199 (2015)
- Tucker SL, "Impact of heart and lung dose on early survival in patients with non-small cell lung cancer treated with chemoradiation", Radiother Oncol, 119, pp.495~500 (2016)