Radiation dose escalation by simultaneous modulated accelerated radiotherapy combined with chemotherapy for esophageal cancer: a phase II study
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Jianzhou Chen1,2,*, Hong Guo1,*, Tiantian Zhai1, Daniel Chang3, Zhijian Chen4, Ruihong Huang1, Wuzhe Zhang1, Kun Lin5, Longjia Guo1, Mingzhen Zhou1, Dongsheng Li1, Derui Li1, Chuangzhen Chen1
1Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
2CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
3Department of Radiation Oncology, Stanford University, Stanford, CA, USA
4Department of Oncology, The University of Hongkong - Shenzhen Hospital, Shenzhen, Guangdong, China
5Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou, Guangdong, China
*These authors have contributed equally to this work
Chuangzhen Chen, e-mail: firstname.lastname@example.org
Derui Li, e-mail: email@example.com
Keywords: esophageal cancer, radiation therapy, dose escalation, simultaneous modulated accelerated radiotherapy, simultaneous integrated boost
Received: November 24, 2015 Accepted: February 23, 2016 Published: March 14, 2016
The outcomes for patients with esophageal cancer (EC) underwent standard-dose radical radiotherapy were still disappointing. This phase II study investigated the feasibility, safety and efficacy of radiation dose escalation using simultaneous modulated accelerated radiotherapy (SMART) combined with chemotherapy in 60 EC patients. Radiotherapy consisted of 66Gy at 2.2 Gy/fraction to the gross tumor and 54Gy at 1.8 Gy/fraction to subclinical diseases simultaneously. Chemotherapy including cisplatin and 5fluorouracil were administered to all patients during and after radiotherapy. The data showed that the majority of patients (98.3%) completed the whole course of radiotherapy and concurrent chemotherapy. The most common ≥ grade 3 acute toxicities were neutropenia (16.7%), followed by esophagitis (6.7%) and thrombopenia (5.0%). With a median follow-up of 24 months (5-38) for all patients and 30 months (18-38) for those still alive, 11 patients (18.3%) developed ≥ Grade 3 late toxicities and 2 (3.3%) of them died subsequently due to esophageal hemorrhage. The 1- and 2-year local-regional control, distant metastasis-free survival, disease-free survival and overall survival rates were 87.6% and 78.6%, 86.0% and 80.5%, 75.6% and 64.4%, 86.7% and 72.7%, respectively. SMART combined with concurrent chemotherapy is feasible in EC patients with tolerable acute toxicities. They showed a trend of significant improvements in local-regional control and overall survival. Further follow-up is needed to evaluate the late toxicities.
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