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Real-World Outcomes of SIB-Based Concurrent Chemoradiation Therapy for Upper-Third Esophageal Cancer: A Single-Center
Trung Bach Tran1,2, Van Xuan Vo2, Xuan Huy Vu2
1Department of Oncology, Hanoi Medical University, Hanoi, Vietnam.
Objectives:
Upper-third esophageal cancer (EC) is a rare malignancy with limited high-quality evidence to guide treatment. Concurrent chemoradiotherapy (CCRT) remains the mainstay approach. This study aimed to evaluate the efficacy and safety of VMAT/IMRT-based CCRT with a simultaneous integrated boost (SIB) in patients with upper-third esophageal squamous cell carcinoma.
Materials And Methods:
We retrospectively reviewed 59 patients treated with definitive SIB-based CCRT at Vietnam National Cancer Hospital between April 2022 and April 2025. All patients received 59.4-61.6 Gy to the gross tumor and involved nodes using VMAT or IMRT. Outcomes included treatment response, failure patterns, survival rates, and toxicities. Progression-free survival (PFS) and prognostic factors were analyzed using Kaplan-Meier and Cox regression methods.
Results:
The complete response rate was 47.5%. One- and two-year PFS rates were 62.4% and 37.2%, respectively; OS rates were 85.0% and 73.1%. Local control at 1 and 2 years was 82.9% and 61.1%. Distant metastasis was the most common failure pattern (59.3%), followed by recurrence at the primary site (48.1%) and regional nodes (40.7%). Grade ≥3 toxicities were infrequent. Pretreatment BMI ≥18.5 kg/m² (p = 0.007) and complete response (p = 0.027) were independently associated with better PFS.
Conclusions:
This study provides the first real-world Vietnamese data on SIB-based CCRT for upper-third esophageal cancer, demonstrating feasibility, tolerability, and promising local control with shorter treatment duration. Distant metastasis remains a major challenge, highlighting the need for improved systemic strategies. Future research should focus on combining SIB with modern systemic therapies and refining boost volume definition using advanced imaging to enhance outcomes and support personalized treatment approaches.
