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Radiation Dose-escalated Chemoradiotherapy Using Simultaneous Integrated Boost Intensity-Modulated Radiotherapy for
K Sakanaka1, Y Ishida1, K Fujii1
1Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|August 10, 2020
Summary
The recommended radiation dose for locally advanced esophageal cancer is 66 Gy. This dose, delivered via simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT), aims to reduce recurrence after chemoradiotherapy.
Area of Science:
- Radiation Oncology
- Medical Oncology
- Gastrointestinal Oncology
Background:
- Locally advanced unresectable thoracic esophageal squamous cell carcinoma has a high recurrence rate (approx. 80%) after chemoradiotherapy.
- Radiation dose escalation is a strategy to improve outcomes by reducing local and regional recurrence.
Purpose of the Study:
- To determine the recommended escalated radiation dose for patients with locally advanced unresectable thoracic esophageal squamous cell carcinoma.
- To evaluate the safety and efficacy of dose-escalated chemoradiotherapy using SIB-IMRT.
Main Methods:
- A phase I/II study using a 3+3 design escalated radiation dose from 66 Gy to 72 Gy in 3 Gy increments.
- Concurrent chemotherapy with cisplatin and 5-fluorouracil was administered.
- Dose-limiting toxicities (DLTs) included acute grade 3 esophagitis and grade 2 pneumonitis or cardiac toxicity.
Main Results:
- The recommended dose was determined to be 66 Gy in 30 fractions, based on DLTs observed at higher doses (69 Gy).
- The 1-year locoregional control rate was 67%, and the 1-year overall survival rate was 78% with a median follow-up of 23 months.
Conclusions:
- The recommended radiation dose for chemoradiotherapy using SIB-IMRT with elective nodal irradiation for this patient group is 66 Gy in 30 fractions.
- This dose escalation strategy shows promising results for locoregional control and overall survival in esophageal cancer.
