(P045) Multimodality Therapy With Intensity-Modulated Radiotherapy for Locally Advanced Esophageal Cancer

Publication
Article
OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Patients who undergo surgery after chemoradiotherapy demonstrate improved survival; however, this may be related to underlying comorbidities that preclude surgery. IMRT appears to be a reasonable treatment option that may reduce complications from radiotherapy. Careful attention should be given to heart dose during treatment planning.

Nitesh N. Paryani, MD, Stephen J. Ko, MD, Corey Hobbs, MD, Kristin Kowalchik, MD, Elizabeth Johnson, MD, Laura Vallow, MD, Jennifer Peterson, MD, Katherine Tzou, MD, Steven J. Buskirk, MD; Mayo Clinic

PURPOSE: The current standard of care for locally advanced esophageal cancer includes chemoradiotherapy with or without surgery. Radiation is usually delivered via a three-dimensional (3D) technique. Intensity-modulated radiation therapy (IMRT) has been utilized in the treatment of multiple tumors and has demonstrated similar efficacy while offering the possibility of decreased toxicity. 

MATERIALS AND METHODS: A total of 36 patients were treated with IMRT and chemotherapy; 21 patients underwent surgical resection-11 underwent open surgery, and the remainder underwent minimally invasive surgery. Chemotherapy consisted primarily of 5-fluorouracil (5-FU) with oxaliplatin or cisplatin. All but two patients received 50.4 Gy; one patient received 41.4 Gy without surgery, and one patient discontinued treatment after 25.2 Gy. Eleven patients required a treatment break during radiotherapy. The median age was 69 years (range: 46–87 yr). Approximately two-thirds of tumors were adenocarcinomas located in the lower thorax. Two-thirds of patients were stage T3 and had positive lymph nodes. The median tumor size was 5 cm (range: 2–13 cm). 

RESULTS: With a median follow-up of 21.3 months for all patients (range: 2.4–44.8 mo) and 33.9 months for survivors (range: 3.7-44.8 mo), overall survival (OS) at 24 months was 55%. The 24-month OS was 75% vs 24% for surgical and nonsurgical patients, respectively. Seven patients had a complete pathologic response. A total of 24 patients experienced grade ≥ 3 acute toxicity, and there was one grade 5 toxicity. Acute toxicity was similar between surgery and nonsurgery patients. Also, 14 patients experienced grade ≥ 3 late toxicity (9 surgery and 5 nonsurgery patients). The most frequent late toxicity was grade 3 stricture (21%). On multivariate analysis, advanced age (relative risk [RR] for 10-year increase in age = 2.01; P = .032) and heart maximum dose > 55 Gy (RR = 3.73; P = .011) were associated with decreased survival.

CONCLUSION: Patients who undergo surgery after chemoradiotherapy demonstrate improved survival; however, this may be related to underlying comorbidities that preclude surgery. IMRT appears to be a reasonable treatment option that may reduce complications from radiotherapy. Careful attention should be given to heart dose during treatment planning. 

Proceedings of the 97th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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