Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Radiation Oncology
Published in: Radiation Oncology 1/2014

Open Access 01-12-2014 | Research

Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer

Authors: Falk Roeder, Nils H Nicolay, Tam Nguyen, Ladan Saleh-Ebrahimi, Vasilis Askoxylakis, Tilman Bostel, Felix Zwicker, Juergen Debus, Carmen Timke, Peter E Huber

Published in: Radiation Oncology | Issue 1/2014

Login to get access

Abstract

Background

To report our experience with increased dose intensity-modulated radiation and concurrent systemic chemotherapy as definitive treatment of locally advanced esophageal cancer.

Patients and methods

We analyzed 27 consecutive patients with histologically proven esophageal cancer, who were treated with increased-dose IMRT as part of their definitive therapy. The majority of patients had T3/4 and/or N1 disease (93%). Squamous cell carcinoma was the dominating histology (81%). IMRT was delivered in step-and-shoot technique in all patients using an integrated boost concept. The boost volume was covered with total doses of 56-60 Gy (single dose 2-2.14 Gy), while regional nodal regions received 50.4 Gy (single dose 1.8 Gy) in 28 fractions. Concurrent systemic therapy was scheduled in all patients and administered in 26 (96%). 17 patients received additional adjuvant systemic therapy. Loco-regional control, progression-free and overall survival as well as acute and late toxicities were retrospectively analyzed. In addition, quality of life was prospectively assessed according to the EORTC QLQs (QLQ-OG25, QLQ-H&N35 and QLQ-C30).

Results

Radiotherapy was completed as planned in all but one patient (96%), and 21 patients received more than 80% of the planned concurrent systemic therapy. We observed ten locoregional failures, transferring into actuarial 1-, 2- and 3-year-locoregional control rates of 77%, 65% and 48%. Seven patients developed distant metastases, mainly to the lung (71%). The actuarial 1-, 2- and 3-year-disease free survival rates were 58%, 48% and 36%, and overall survival rates were 82%, 61% and 56%. The concept was well tolerated, both in the clinical objective examination and also according to the subjective answers to the QLQ questionnaire. 14 patients (52%) suffered from at least one acute CTC grade 3/4 toxicity, mostly hematological side effects or dysphagia. Severe late toxicities were reported in 6 patients (22%), mostly esophageal strictures and ulcerations. Severe side effects to skin, lung and heart were rare.

Conclusion

IMRT with concurrent systemic therapy in the definitive treatment of esophageal cancer using an integrated boost concept with doses up to 60 Gy is feasible and yields good results with acceptable acute and late overall toxicity and low side effects to skin, lung and heart.
Appendix
Available only for authorised users
Literature
1.
Pennathur A, Gibson MK, Jobe BA, Luketich JD: Oesophageal carcinoma. Lancet 2013,381(9864):400-412. 10.1016/S0140-6736(12)60643-6CrossRefPubMed
2.
Siegel R, Naishadham D, Jemal A: Cancer statistics, 2013. CA Cancer J Clin 2013,63(1):11-30. 10.3322/caac.21166CrossRefPubMed
3.
Pohl H, Welch HG: The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst 2005,97(2):142-146. 10.1093/jnci/dji024CrossRefPubMed
4.
Enzinger PC, Mayer RJ: Esophageal cancer. N Engl J Med 2003,349(23):2241-2252. 10.1056/NEJMra035010CrossRefPubMed
5.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ: Cancer statistics, 2009. CA Cancer J Clin 2009,59(4):225-249. 10.3322/caac.20006CrossRefPubMed
6.
Kamangar F, Dores GM, Anderson WF: Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006,24(14):2137-2150. 10.1200/JCO.2005.05.2308CrossRefPubMed
7.
Umar SB, Fleischer DE: Esophageal cancer: epidemiology, pathogenesis and prevention. Nat Clin Pract Gastroenterol Hepatol 2008,5(9):517-526. 10.1038/ncpgasthep1223CrossRef
8.
Lagergren J, Lagergren P: Recent developments in esophageal adenocarcinoma. CA Cancer J Clin 2013,63(4):232-248. 10.3322/caac.21185CrossRefPubMed
9.
Wheeler JB, Reed CE: Epidemiology of esophageal cancer. Surg Clin North Am 2012,92(5):1077-1087. 10.1016/j.suc.2012.07.008CrossRefPubMed
10.
Pennathur A, Zhang J, Chen H, Luketich JD: The “best operation” for esophageal cancer? Ann Thorac Surg 2010,89(6):S2163-S2167. 10.1016/j.athoracsur.2010.03.068PubMedCentralCrossRefPubMed
11.
Nieman DR, Peters JH: Treatment strategies for esophageal cancer. Gastroenterol Clin North Am 2013,42(1):187-197. 10.1016/j.gtc.2012.11.007CrossRefPubMed
12.
Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J, Australasian Gastro-Intestinal Trials G: Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 2007,8(3):226-234. 10.1016/S1470-2045(07)70039-6CrossRefPubMed
13.
Courrech Staal EF, Aleman BM, Boot H, van Velthuysen ML, van Tinteren H, van Sandick JW: Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer. Br J Surg 2010,97(10):1482-1496. 10.1002/bjs.7175CrossRefPubMed
14.
Shahbaz Sarwar CM, Luketich JD, Landreneau RJ, Abbas G: Esophageal cancer: an update. Int J Surg 2010,8(6):417-422. 10.1016/j.ijsu.2010.06.011CrossRefPubMed
15.
Herskovic A, Martz K, Al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992,326(24):1593-1598. 10.1056/NEJM199206113262403CrossRefPubMed
16.
Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, Byhardt R, Russell AH, Beitler JJ, Spencer S, Asbell SO, Graham MV, Leichman LL: Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999,281(17):1623-1627.CrossRefPubMed
17.
Teoh AY, Chiu PW, Yeung WK, Liu SY, Wong SK, Ng EK: Long-term survival outcomes after definitive chemoradiation versus surgery in patients with resectable squamous carcinoma of the esophagus: results from a randomized controlled trial. Ann Oncol 2013,24(1):165-171. 10.1093/annonc/mds206CrossRefPubMed
18.
Morgan MA, Lewis WG, Casbard A, Roberts SA, Adams R, Clark GW, Havard TJ, Crosby TD: Stage-for-stage comparison of definitive chemoradiotherapy, surgery alone and neoadjuvant chemotherapy for oesophageal carcinoma. Br J Surg 2009,96(11):1300-1307. 10.1002/bjs.6705CrossRefPubMed
19.
Crosby T, Hurt CN, Falk S, Gollins S, Mukherjee S, Staffurth J, Ray R, Bashir N, Bridgewater JA, Geh JI, Cunningham D, Blazeby J, Roy R, Maughan T, Griffiths G: Chemoradiotherapy with or without cetuximab in patients with oesophageal cancer (SCOPE1): a multicentre, phase 2/3 randomised trial. Lancet Oncol 2013,14(7):627-637. 10.1016/S1470-2045(13)70136-0CrossRefPubMed
20.
Kachnic LA, Winter K, Wasserman T, Kelsen D, Ginsberg R, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA, Willett CG, Minsky BD: Longitudinal quality-of-life analysis of RTOG 94-05 (Int 0123):a phase III trial of definitive chemoradiotherapy for esophageal cancer. Gastrointest Cancer Res 2011,4(2):45-52.PubMedCentralPubMed
21.
Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA, Kelsen DP: 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 2002,20(5):1167-1174. 10.1200/JCO.20.5.1167CrossRefPubMed
22.
Pottgen C, Stuschke M: Radiotherapy versus surgery within multimodality protocols for esophageal cancer–a meta-analysis of the randomized trials. Cancer Treat Rev 2012,38(6):599-604. 10.1016/j.ctrv.2011.10.005CrossRefPubMed
23.
Smit JK, Muijs CT, Burgerhof JG, Paardekooper G, Timmer PR, Muller K, Woutersen D, Mul VE, Beukema JC, Hospers GA, van Dijk BA, Langendijk JA, Plukker JT: Survival after definitive (chemo)radiotherapy in esophageal cancer patients: a population-based study in the north-East Netherlands. Ann Surg Oncol 2013,20(6):1985-1992. 10.1245/s10434-012-2824-2CrossRefPubMed
24.
Minsky BD, Neuberg D, Kelsen DP, Pisansky TM, Ginsberg RJ, Pajak T, Salter M, Benson AB 3rd: Final report of Intergroup Trial 0122 (ECOG PE-289, RTOG 90-12): Phase II trial of neoadjuvant chemotherapy plus concurrent chemotherapy and high-dose radiation for squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 1999,43(3):517-523. 10.1016/S0360-3016(98)00463-5CrossRefPubMed
25.
Geh JI, Bond SJ, Bentzen SM, Glynne-Jones R: Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol 2006,78(3):236-244. 10.1016/j.radonc.2006.01.009CrossRefPubMed
26.
Fakhrian K, Oechsner M, Kampfer S, Schuster T, Molls M, Geinitz H: Advanced techniques in neoadjuvant radiotherapy allow dose escalation without increased dose to the organs at risk: planning study in esophageal carcinoma. Strahlenther Onkol 2013,189(4):293-300. 10.1007/s00066-012-0297-7CrossRefPubMed
27.
Yin L, Wu H, Gong J, Geng JH, Jiang F, Shi AH, Yu R, Li YH, Han SK, Xu B, Zhu GY: Volumetric-modulated arc therapy vs. c-IMRT in esophageal cancer: a treatment planning comparison. World J Gastroenterol 2012,18(37):5266-5275.PubMedCentralPubMed
28.
Nicolini G, Ghosh-Laskar S, Shrivastava SK, Banerjee S, Chaudhary S, Agarwal JP, Munshi A, Clivio A, Fogliata A, Mancosu P, Vanetti E, Cozzi L: Volumetric modulation arc radiotherapy with flattening filter-free beams compared with static gantry IMRT and 3D conformal radiotherapy for advanced esophageal cancer: a feasibility study. Int J Radiat Oncol Biol Phys 2012,84(2):553-560. 10.1016/j.ijrobp.2011.12.041CrossRefPubMed
29.
Welsh J, Palmer MB, Ajani JA, Liao Z, Swisher SG, Hofstetter WL, Allen PK, Settle SH, Gomez D, Likhacheva A, Cox JD, Komaki R: Esophageal cancer dose escalation using a simultaneous integrated boost technique. Int J Radiat Oncol Biol Phys 2012,82(1):468-474. 10.1016/j.ijrobp.2010.10.023PubMedCentralCrossRefPubMed
30.
Button MR, Morgan CA, Croydon ES, Roberts SA, Crosby TD: Study to determine adequate margins in radiotherapy planning for esophageal carcinoma by detailing patterns of recurrence after definitive chemoradiotherapy. Int J Radiat Oncol Biol Phys 2009,73(3):818-823. 10.1016/j.ijrobp.2008.04.062CrossRefPubMed
31.
Lambrecht M, Haustermans K: Clinical evidence on PET-CT for radiation therapy planning in gastro-intestinal tumors. Radiother Oncol 2010,96(3):339-346. 10.1016/j.radonc.2010.07.019CrossRefPubMed
32.
Yu W, Fu XL, Zhang YJ, Xiang JQ, Shen L, Chang JY: A prospective evaluation of staging and target volume definition of lymph nodes by 18FDG PET/CT in patients with squamous cell carcinoma of thoracic esophagus. Int J Radiat Oncol Biol Phys 2011,81(5):e759-e765. 10.1016/j.ijrobp.2010.10.065CrossRefPubMed
33.
Vali FS, Nagda S, Hall W, Sinacore J, Gao M, Lee SH, Hong R, Shoup M, Emami B: Comparison of standardized uptake value-based positron emission tomography and computed tomography target volumes in esophageal cancer patients undergoing radiotherapy. Int J Radiat Oncol Biol Phys 2010,78(4):1057-1063. 10.1016/j.ijrobp.2009.09.022CrossRefPubMed
34.
Muijs CT, Schreurs LM, Busz DM, Beukema JC, van der Borden AJ, Pruim J, Van der Jagt EJ, Plukker JT, Langendijk JA: Consequences of additional use of PET information for target volume delineation and radiotherapy dose distribution for esophageal cancer. Radiother Oncol 2009,93(3):447-453. 10.1016/j.radonc.2009.08.030CrossRefPubMed
35.
Gondi V, Bradley K, Mehta M, Howard A, Khuntia D, Ritter M, Tome W: Impact of hybrid fluorodeoxyglucose positron-emission tomography/computed tomography on radiotherapy planning in esophageal and non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2007,67(1):187-195. 10.1016/j.ijrobp.2006.09.033CrossRefPubMed
36.
Pfau PR, Pham H, Ellis R, Das A, Isenberg G, Chak A: A novel use of endoscopic clips in the treatment planning for radiation therapy (XRT) of esophageal cancer. J Clin Gastroenterol 2005,39(5):372-375. 10.1097/01.mcg.0000159227.40166.01CrossRefPubMed
37.
Han C, Schiffner DC, Schultheiss TE, Chen YJ, Liu A, Wong JY: Residual setup errors and dose variations with less-than-daily image guided patient setup in external beam radiotherapy for esophageal cancer. Radiother Oncol 2012,102(2):309-314. 10.1016/j.radonc.2011.07.027CrossRefPubMed
38.
Hawkins MA, Aitken A, Hansen VN, McNair HA, Tait DM: Set-up errors in radiotherapy for oesophageal cancers–is electronic portal imaging or conebeam more accurate? Radiother Oncol 2011,98(2):249-254. 10.1016/j.radonc.2010.11.002CrossRefPubMed
39.
McBride SM, Parambi RJ, Jang JW, Goldsmith T, Busse PM, Chan AW: Intensity-modulated versus conventional radiation therapy for oropharyngeal carcinoma: Long-term dysphagia and tumor control outcomes. Head Neck 2013. doi:10.1002/hed.23319
40.
Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991,21(1):109-122. 10.1016/0360-3016(91)90171-YCrossRefPubMed
41.
Tuna Y, Kocak E, Dincer D, Koklu S: Factors affecting the success of endoscopic bougia dilatation of radiation-induced esophageal stricture. Dig Dis Sci 2012,57(2):424-428. 10.1007/s10620-011-1875-8CrossRefPubMed
42.
Muijs CT, Beukema JC, Mul VE, Plukker JT, Sijtsema NM, Langendijk JA: External beam radiotherapy combined with intraluminal brachytherapy in esophageal carcinoma. Radiother Oncol 2012,102(2):303-308. 10.1016/j.radonc.2011.07.021CrossRefPubMed
43.
Wu VW, Sham JS, Kwong DL: Inverse planning in three-dimensional conformal and intensity-modulated radiotherapy of mid-thoracic oesophageal cancer. Br J Radiol 2004,77(919):568-572. 10.1259/bjr/19972578CrossRefPubMed
44.
Fenkell L, Kaminsky I, Breen S, Huang S, Van Prooijen M, Ringash J: Dosimetric comparison of IMRT vs. 3D conformal radiotherapy in the treatment of cancer of the cervical esophagus. Radiother Oncol 2008,89(3):287-291. 10.1016/j.radonc.2008.08.008CrossRefPubMed
45.
Vosmik M, Petera J, Sirak I, Hodek M, Paluska P, Dolezal J, Kopacova M: Technological advances in radiotherapy for esophageal cancer. World J Gastroenterol 2010,16(44):5555-5564. 10.3748/wjg.v16.i44.5555PubMedCentralCrossRefPubMed
46.
Anbai A, Koga M, Motoyama S, Jin M, Shibata H, Hashimoto M: Outcomes of patients with stage IVA esophageal cancer (Japanese classification) treated with definitive chemoradiotherapy. Jpn J Radiol 2013,31(4):270-276. 10.1007/s11604-013-0180-1CrossRefPubMed
47.
Monjazeb AM, Blackstock AW: The impact of multimodality therapy of distal esophageal and gastroesophageal junction adenocarcinomas on treatment-related toxicity and complications. Semin Radiat Oncol 2013,23(1):60-73. 10.1016/j.semradonc.2012.09.006CrossRefPubMed
Metadata
Title
Intensity modulated radiotherapy (IMRT) with concurrent chemotherapy as definitive treatment of locally advanced esophageal cancer
Authors
Falk Roeder
Nils H Nicolay
Tam Nguyen
Ladan Saleh-Ebrahimi
Vasilis Askoxylakis
Tilman Bostel
Felix Zwicker
Juergen Debus
Carmen Timke
Peter E Huber
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-9-191

Other articles of this Issue 1/2014

Radiation Oncology 1/2014 Go to the issue

Research

Effect of combined irradiation and EGFR/Erb-B inhibition with BIBW 2992 on proliferation and tumour cure in cell lines and xenografts

Research

Proctitis following stereotactic body radiation therapy for prostate cancer

Research

Making the right software choice for clinically used equipment in radiation oncology

Research

Dosimetric robustness against setup errors in charged particle radiotherapy of skull base tumors

Research

Evaluation of volumetric modulated arc therapy for postmastectomy treatment

Research

Linac-based stereotactic radiotherapy and radiosurgery in patients with meningioma