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Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institutional retrospective study

Authors: Hideomi Yamashita, Ryousuke Takenaka, Mami Omori, Toshikazu Imae, Kae Okuma, Kuni Ohtomo, Keiichi Nakagawa

Published in: Radiation Oncology | Issue 1/2015

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Abstract

Background

This retrospective study on early and locally advanced esophageal cancer was conducted to evaluate locoregional failure and its impact on survival by comparing involved field radiotherapy (IFRT) with elective nodal irradiation (ENI) in combination with concurrent chemotherapy.

Methods

We assessed all patients with esophageal cancer of stages I-IV treated with definitive radiotherapy from June 2000 to March 2014. Between 2000 and 2011, ENI was used for all cases excluding high age cases. After Feb 2011, a prospective study about IFRT was started, and therefore IFRT was used since then for all cases. Concurrent chemotherapy regimen was nedaplatin (80 mg/m2 at D1 and D29) and 5-fluorouracil (800 mg/m2 at D1-4 and D29-32).

Results

Of the 239 consecutive patients assessed (120 ENI vs. 119 IFRT), 59 patients (24.7 %) had stage IV disease and all patients received at least one cycle of chemotherapy. The median follow-up time for survivors was 34.0 months. There were differences in 3-year local control (44.8 % vs. 55.5 %, p = 0.039), distant control (53.8 % vs. 69.9 %, p = 0.021) and overall survival (34.8 % vs. 51.6 %, p = 0.087) rates between ENI vs. IFRT, respectively. Patients treated with IFRT (8 %) demonstrated a significantly lower risk (p = 0.047) of high grade late toxicities than with ENI (16 %). IFRT did not increase the risk of initially uninvolved or isolated nodal failures (27.5 % in ENI and 13.4 % in IFRT).

Conclusions

Nodal failure rates in clinically uninvolved nodal stations were not increased with IFRT when compared to ENI. IFRT also resulted in significantly decreased esophageal toxicity, suggesting that IFRT may allow for integration of concurrent systemic chemotherapy in a greater proportion of patients. Both tendencies of improved loco-regional progression-free survival and a significant increased overall survival rate favored the IFRT arm over the ENI arm in this study.
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Metadata
Title
Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institutional retrospective study
Authors
Hideomi Yamashita
Ryousuke Takenaka
Mami Omori
Toshikazu Imae
Kae Okuma
Kuni Ohtomo
Keiichi Nakagawa
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0482-9

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