Radiotherapy Combined With Concurrent Nedaplatin-Based Chemotherapy for Stage II-III Esophageal Squamous Cell...

Area of Science:

• Radiation Oncology
• Medical Oncology
• Gastroenterology

Background:

• Esophageal squamous cell carcinoma (ESCC) is a significant cause of cancer mortality worldwide.
• Concurrent chemoradiotherapy (CCRT) is a standard treatment for inoperable stage II-III ESCC.
• Optimizing radiation dosage in CCRT is crucial for improving patient outcomes and managing toxicity.

Purpose of the Study:

• To determine the optimal radical radiation dose for CCRT in patients with inoperable stage II-III ESCC.
• To compare the efficacy and toxicity of 60 Gy versus 50.4 Gy radiation doses in nedaplatin-based CCRT.

Main Methods:

• Retrospective analysis of 112 patients with inoperable stage II-III ESCC treated with CCRT.
• Patients received either 60 Gy (high dose, HD) or 50.4 Gy (low dose, LD) of intensity-modulated radiation therapy (IMRT) with nedaplatin-based chemotherapy.
• Outcomes assessed included overall survival (OS), progression-free survival (PFS), objective remission rate (ORR), failure patterns, and toxicities.

Main Results:

• The 60 Gy group demonstrated significantly superior OS (median 25.5 vs 17.5 months, P=.021) and a trend towards longer PFS (median 14.0 vs 10.5 months, P=.076) compared to the 50.4 Gy group.
• A higher complete remission rate (CR) was observed in the 60 Gy group (P=.016).
• While toxicities were generally acceptable, the 60 Gy dose was associated with a higher incidence of grade ≥3 late radiotoxicity (22.4% vs 5.6%, P=.011).

Conclusions:

• A 60 Gy radiation dose in nedaplatin-based CCRT appears to achieve a better prognosis for patients with stage II-III ESCC.
• The findings suggest that 60 Gy is a more effective radical dose than 50.4 Gy for this patient population.
• Careful monitoring for late toxicities is warranted when using the higher radiation dose.