Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analys
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RESEARCH
Open Access
Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analysis Mina Liu1, Kuaile Zhao2,3, Yun Chen2,3 and Guo-Liang Jiang2,3*
Abstract Background: A retrospective study to compare the failure patterns and effects of elective nodal irradiation (ENI) or involved field irradiation (IFI) for cervical and upper thoracic esophageal squamous cell carcinoma (SCC) patients. Methods: One hundred and sixty nine patients with the cervical and upper thoracic esophageal SCC were analyzed retrospectively; 99 patients (59%) underwent IFI and 70 patients (41%) received ENI. We defined “Out-PTVifi in-PTVeni metastasis” as lymph node metastasis occurring in the cervical prophylactic field of PTVeni thus out of PTVifi. Results: Out-PTVifi in-PTVeni cervical node metastasis occurred in 8% of patients in the IFI group, all within 2 years after treatment. However, it occurred in 10% of patients in the ENI group, and these failures happened gradually since one year after treatments. No difference was found in OS and the incidences of Grade ≥ 3 treatment-related esophageal and lung toxicities between the two groups. Conclusions: ENI for cervical and upper thoracic esophageal SCC patients did not bring longer OS and better long-term control of cervical lymph nodes. Although ENI might delay cervical nodes progression in elective field; it could not decrease the incidence of these failures. Keywords: Esophageal squamous cell carcinoma, Radiotherapy, Elective nodes irradiation, Cervical failures
Background Esophageal carcinoma is one of the most common cancers in the world with an estimated 482,300 new cases and 406,800 deaths yearly worldwide [1]. Definitive chemoradiotherapy is widely used as the standard of care [2-4]. Whether ENI should be performed has always been a controversy, especially for cervical and upper thoracic esophageal squamous cell carcinoma (SCC). We retrospectively studied different failure patterns for patients who had ENI and who had not, investigated the effects for them.
* Correspondence: [email protected] 1 Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao tong University, Shanghai 200030, China 2 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai 200032, China 3 Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong An Road, Shanghai 200032, China
Materials and methods Patient selection criteria
Patients who met the following criteria were included for this study: (1) confirmation of esophageal SCC by histology or cytology; (2) no prior therapy (what therapy?); (3) no previous malignancies; (4) complete clinical data; (5) tumors proved to be located in cervical or upper thoracic esophagus by endoscopy. Patients who had been treated with surgery were excluded. A total of 350 consecutive patients with esophageal cancer were treated with definitive chemoradiotherapy at a single institution (Fudan University Shanghai Cancer Center) between
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