Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for
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ORIGINAL ARTICLE
Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer Yukihiro Nakatani1,3 · Ken Kato1 · Hirokazu Shoji1 · Satoru Iwasa1 · Yoshitaka Honma1 · Atsuo Takashima1 · Toshikazu Ushijima2,3 · Yoshinori Ito4 · Jun Itami5 · Narikazu Boku1 Received: 11 October 2019 / Accepted: 3 March 2020 © Japan Society of Clinical Oncology 2020
Abstract Background The optimal radiation field of chemoradiation therapy (CRT) for stage I esophageal squamous cell carcinoma (ESCC) is unknown. This retrospective study compared efficacy and safety of two CRT modalities, involved field irradiation (IFI) and elective nodal irradiation (ENI), when treating patients with clinical stage I (T1bN0M0) ESCC. Methods Patients had received 60 Gy CRT concurrently with 5-FU and cisplatin between January 2000 and December 2012. The clinical target volume of IFI was limited to the primary tumor plus a 2-cm craniocaudal margin; that of ENI covered the primary tumor plus the field of regional lymph nodes. Results One hundred and ninety-five patients were selected (IFI group, 78; ENI group, 117). The 5-year overall, causespecific and progression-free survival rates were 90.5%, 91.6% and 77.6% in the IFI group, and 72.5%, 88.3%, 57.9% in the ENI group, respectively. Of recurrent patients (n = 16 in the IF and n = 33 in the ENI groups) after achieving complete remission, 12 (75%) in the IFI group received definitive salvage therapy, 11 (33%) patients did in the ENI group. More patients died of diseases other than esophageal cancer in the ENI group (n = 29, 25%) than in the IFI group (n = 3, 3.8%). Multivariate analysis identified ENI (HR 3.63 [1.78–7.38], p 10 mm in the long axis were detected. In some cases, endoscopic ultrasonography (EUS) and positron emission tomography (PET) were also used if a small lymph node was suspected to have the metastasis. Depth of the tumor (T stage) and N stage were determined following a multidisciplinary evaluation by endoscopists, radiologists, surgeons and gastrointestinal oncologists. Patients satisfying the following criteria were selected as subjects of this study: (1) newly diagnosed with squamous cell cancer of the thoracic esophagus, (2) no prior treatment, (3) Eastern Cooperative Oncology Group performance status of 0 or 1, (4) receiving chemotherapy comprised 5-FU and cisplatin (700 mg/m2, days 1–4, 29–32,
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International Journal of Clinical Oncology
and 70 mg/m2, day 1, 29), (5) radiotherapy with a total dose of 60 Gy with IFI or ENI, and (6) no other malignancy. Among 242 patients, 47 were excluded from this study because of treatment with another chemotherapy regimen containing nedaplatin (n = 4), other radiation procedure (n = 2) or the presence of double cancer (n = 41). The final study population therefore included 195 esophageal cancer patients with cT1bN0M0 who underwent definitive CRT. Prior to simulation for determining the radiation field, an endoscope was used to place metal clip markers a
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