Impact of Intensity-Modulated Radiotherapy with Concurrent Chemotherapy on Survival for Patients with Cervical Esophageal Carcinoma

Publication date: Available online 9 January 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Lachlan J. McDowell, Shao Hui Huang, Wei Xu, Jiahua Che, Rebecca K.S. Wong, James Brierley, John Kim, Bernard Cummings, John Waldron, Andrew Bayley, Aaron Hansen, Ian Witterick, Jolie Ringash
Purpose/ObjectivesWe evaluated the impact of consecutive protocols on overall survival (OS) for cervical esophageal carcinoma (CEC).Materials/MethodsAll CEC cases treated with definitive radiotherapy (RT) +/- chemotherapy (CTx) from 1997-2013 were reviewed in 3 consecutive protocols: Protocol 1 (P1): two-dimensional radiotherapy (2DRT), 54 Gy/20 fractions [f] with 5-fluorouracil plus either mitomycin C or cisplatin; P2: three-dimensional conformal radiotherapy (3DRT), ≥60 Gy/30f + elective nodal irradiation [ENI]) + cisplatin); P3: intensity-modulated radiotherapy (IMRT), ≥60 Gy/30f + ENI + cisplatin. Multivariable analyses (MVA) assessed the impact of treatment protocol, RT technique and RT dose on OS, separately.ResultsAmong 81 cases (P1: 21; P2: 23; P3: 37), 34 local (P1: 11 [52%]; P2: 12 [52%], P3: 11 [30%]), 16 regional (P1: 6 [29%); P2: 3 [13%]; P3: 7[19%]), and 34 distant (P1: 10 [48%]; P2: 9 [39%]; P3: 15 [41%]) failures were identified. After adjusting for age (p=0.49) and CTx (any vs. none: HR 0.5 [0.3-0.9], p=0.023), MVA showed P3 had improved OS vs. P1 (HR 0.4 [0.2-0.8], p=0.005) and trended to benefit vs. P2 (HR 0.6 [0.3-1.0], p=0.061); P1 and P2 did not differ (p=0.29). Analyzed as a continuous variable, higher RT doses were associated with a borderline improved OS (HR 0.97 [0.95-1.0], p=0.075). IMRT showed improved OS versus non-IMRT (HR 0.57 [0.3-0.8], p=0.008).ConclusionsThis retrospective consecutive cohort study showed improved OS with our current protocol (high-dose IMRT with concurrent high-dose cisplatin) compared to historical protocols. Outcomes in CEC remain poor and novel approaches to improve the therapeutic ratio are warranted.



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