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Li J, Zhou X, Liu Y, Zhu J, Wan G, Wang Y, Leng X, Han Y, Peng L, Wu L, Wang Q. Optimal Time-to-Surgery Recommendations Based on Primary Tumor Volume Regression for Patients with Resectable Esophageal Cancer after Neoadjuvant Chemoradiotherapy: A Retrospective Study. Ann Surg Oncol 2024; 31:3803-3812. [PMID: 38280959 DOI: 10.1245/s10434-024-14941-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (NCRT) has shown promise in improving the prognosis of individuals with locally advanced esophageal squamous cell carcinoma (LA-ESCC). However, the factors influencing tumor response and long-term survival in these patients remain unknown. The optimal timing for surgery after the completion of radiotherapy in LA-ESCC remains controversial. Therefore, this study was designed to identify biomarkers and to determine the optimal post-NCRT time-to-surgery (TTS) for patients with LA-ESCC. METHODS This retrospective study included patients with resectable LA-ESCC who underwent NCRT between May 2017 and June 2021. The tumor shrinkage rate was calculated as the difference between the pre- and post-primary gross tumor volume (GTVp) divided by the pre-GTVp. Univariate and multivariate Cox regression analyses and Kaplan-Meier curves were used to calculate overall survival (OS) and progression-free survival (PFS). RESULTS We collected data from 248 patients with resectable LA-ESCC who underwent computed tomography (CT) scans before the initiation of treatment. The median follow-up time was 37.7 months. The optimal cutoff of tumor shrinkage was 45%. In the univariate and multivariate analyses, we found a significant association between the tumor shrinkage rate and PFS (p = 0.001). Among the subgroup of patients who responded to treatment, extending the TTS was associated with improved OS (p = 0.037) and PFS (p = 0.028). CONCLUSIONS For patients with resectable LA-ESCC, the tumor shrinkage rate is an independent prognostic factor for PFS. Thus, for responders, prolonging TTS is recommended to obtain a better OS.
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Affiliation(s)
- Jingqiu Li
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoding Zhou
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Liu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Clinical Medical College, Chengdu Medical College, Chengdu, China
| | - Jie Zhu
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Gang Wan
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Wang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Lei Wu
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
| | - Qifeng Wang
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Ou Y, Li H, Yang D, Suo L. Effects of intensity-modulated radiotherapy combined with chemotherapy and prognostic factors in patients with locally advanced oesophageal cancer. Adv Med Sci 2024; 69:125-131. [PMID: 38438081 DOI: 10.1016/j.advms.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/26/2023] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE We explored the efficacy and influencing factors of chemoradiotherapy and radiotherapy alone in patients with locally advanced oesophageal squamous cell carcinoma. METHODS We retrospectively analysed 226 locally advanced oesophageal squamous cell carcinoma patients who underwent chemoradiotherapy and radiotherapy alone. Univariate and multivariate Cox regression analyses were used to analyse the impact of relevant factors. The endpoint was overall survival and progression-free survival. RESULTS Compared with the radiotherapy group, the chemoradiotherapy group had a significant difference in the overall survival rate and the progression-free survival rate between 3 and 5 years (both p < 0.05). The incidences of radiation pneumonitis and radiation oesophagitis were analysed, and the differences were not significant (all p > 0.05). The incidence of haematological toxicity in the chemoradiotherapy group was significantly higher than that in the radiotherapy group (p = 0.001). There was a significant difference in the incidence of haematological toxicity between the ≤65 and the >65 age groups (p < 0.05). Tumour location, T stage, tumour length, tumour target volume, and short-term curative effect were the main factors affecting the prognosis (all p < 0.05). T stage, gross tumour volume, and short-term curative effect were all independent factors affecting the prognosis (all p < 0.05). CONCLUSIONS Patients with locally advanced oesophageal cancer who received intensity-modulated radiotherapy (IMRT) combined with chemotherapy had significant survival benefits compared with radiotherapy alone. Haematological toxicity was the main adverse reaction. T-stage, gross tumour volume and short-term curative effect were independent factors influencing the prognosis.
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Affiliation(s)
- Yao Ou
- Department of Radiotherapy, Changzhou Tumor Hospital (Changzhou Fourth People's Hospital), Changzhou, Jiangsu, China.
| | - Hongbo Li
- Department of Radiotherapy, Changzhou Tumor Hospital (Changzhou Fourth People's Hospital), Changzhou, Jiangsu, China
| | - Dan Yang
- Department of Radiotherapy, Changzhou Tumor Hospital (Changzhou Fourth People's Hospital), Changzhou, Jiangsu, China
| | - Lijun Suo
- Quality Management Office, Changzhou Tumor Hospital (Changzhou Fourth People's Hospital), Changzhou, Jiangsu, China
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Gui Z, Hu W, Kong Q, Liu C, Xu Y, Wang F. Esophageal stenosis as an independent factor of poor prognosis in patients with ESCC treated with definitive chemoradiotherapy. Future Oncol 2022; 18:4193-4207. [PMID: 36651337 DOI: 10.2217/fon-2022-0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aim: To evaluate the clinical outcome and elucidate the prognostic factors in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive chemoradiotherapy (CRT). Patients: Data for patients newly diagnosed with ESCC receiving definitive CRT at our institution between 2012 and 2018 were retrospectively reviewed. Results: A total of 201 patients were included. Severe stenosis after radiotherapy was an independent factor relevant to prognosis. Maximal esophageal wall thickness, short-term responses, severe stenosis at diagnosis and a high neutrophil-to-lymphocyte ratio were independent risk factors for the occurrence of severe stenosis after radiotherapy. Conclusion: Severe stenosis after radiotherapy is a useful predictive indicator in patients with ESCC receiving definitive CRT. Further studies are needed to verify these findings.
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Affiliation(s)
- Zhongxuan Gui
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Wenjun Hu
- Department of Radiation Oncology, Anhui Chest Hospital, Hefei, Anhui, 230022, People's Republic of China
| | - Qi Kong
- Department of Radiation Oncology, Anhui Second People's Hospital, Hefei, Anhui, 230012, People's Republic of China
| | - Can Liu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Yuechen Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, People's Republic of China
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Li Y, Li Y, Huang H, Guo Z, Zhang K, Zhang W, Pang Q, Wang P. Prognostic values of the gross volume of metastatic lymph nodes in patients with esophageal squamous cell carcinoma treated with definitive concurrent chemoradiotherapy. Front Oncol 2022; 12:996293. [DOI: 10.3389/fonc.2022.996293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
PurposeWe aim to explore whether the gross volume of metastatic lymph nodes (GTVnd) and the gross volume of primary tumor (GTVp) could be prognostic factors for esophageal squamous cell carcinoma (ESCC) patients treated with definitive concurrent chemoradiotherapy (dCCRT).MethodsWe retrospectively analyzed 252 ESCC patients treated with dCCRT in the era of intensity-modulated radiation therapy (IMRT) at our institution. The cut-off value for the GTVnd derived from the restricted cubic splines (RCS) was determined. Univariate and multivariate Cox proportional hazard models were performed to determine the association between GTVnd and prognosis. we performed recursive partitioning analysis (RPA) method using GTVnd to develop a new risk stratification (TGTVndM). Moreover, the linear trend χ2, likelihood ratio χ2, and akaike information criterion (AIC) were used to determine the prognostic value between the TNM and TGTVndM staging systems.ResultsThe five-year overall survival (OS) rate was 30.6%, with a median follow-up of 38 months. The cut-off value of GTVnd determined by the RCS was 4.35 cm3. GTVnd≥4.35 cm3 was an independent and significant negative prognostic factor for OS (HR=1.949, P<0.001), progression free survival (PFS) (HR=1.425, P=0.048), and distance metastasis free survival (DMFS) (HR=2.548, P=0.001). In multivariable analysis, gender, clinical T stage, and GTVnd were independently associated with OS. RPA segregated patients into 3 prognostic groups: high risk (T1-4 GTVnd≥4.35, n=126, III stage), intermediate risk (T4 GTVnd<4.35,n=38,II stage), and low risk(T1-3GTVnd<4.35, n=88, I stage). The 5-year OS(P<0.001), PFS (P=0.002), and DMFS (P=0.001) were significantly worse in high-risk group in comparison with the intermediate and low risk groups. Compared with the TNM staging system, the clinical T stage combined with GTVnd (TGTVndM) had a higher linear trend χ2 (26.38 versus 25.77), higher likelihood ratio χ2 (24.39 versus 20.69), and lower AIC (1255.07 versus 1260.06).ConclusionsGTVnd may serve as a good prognostic factor in predicting distant metastasis and death for ESCC patients treated with dCCRT. The TGTVndM staging system demonstrated superior accuracy for predicting OS and could serve as a more effective prognostic guidance for unresectable ESCC patients.
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Impact of Blood Parameters and Normal Tissue Dose on Treatment Outcome in Esophageal Cancer Patients Undergoing Neoadjuvant Radiochemotherapy. Cancers (Basel) 2022; 14:cancers14143504. [PMID: 35884564 PMCID: PMC9320742 DOI: 10.3390/cancers14143504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Despite technological advances, normal tissue sparing in photon beam irradiation is still challenging. Since in esophageal cancer this may inflict damage on the lungs, heart and bone marrow, possibly impacting on outcome, the aim of this study was to investigate the association of normal tissue dose and blood parameters on the survival of patients having undergone neoadjuvant radiochemotherapy (RCTx) followed by surgery. This retrospective study included 125 patients irradiated to 40−41.4 Gy with photons or protons combined with concurrent chemotherapy. On initial and restaging 18F-FDG-PET/CT, the lungs and heart were contoured as organs at risk for which standardized uptake values (SUV) were evaluated. The mean radiation dose (Dmean) to the lungs and heart, the volume of the lungs receiving at least 20 Gy (V20Gy_lung) and various pre- and per-treatment blood parameters were included in the Cox regression analyses. Results: The median follow-up time was 19.8 months and median overall survival 37 months (95% confidence interval: 16−58.9 months). In multivariate analysis, higher radiation doses to the lungs and heart were statistically significantly associated with decreased overall survival (Dmean_lung: p < 0.001; V20Gy_lung: p < 0.002; Dmean_heart: p = 0.005). Neither the 18F-FDG-PET nor blood parameters were predictive for overall survival. In patients with locally advanced esophageal cancer treated with RCTx, the radiation dose to the heart and lungs was significantly associated with overall survival.
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Bridges S, Thomas B, Radhakrishna G, Hawkins M, Holborow A, Hurt C, Mukherjee S, Nixon L, Crosby T, Gwynne S. SCOPE 2 - Still Answering the Unanswered Questions in Oesophageal Radiotherapy? SCOPE 2: a Randomised Phase II/III Trial to Study Radiotherapy Dose Escalation in Patients with Oesophageal Cancer Treated with Definitive Chemoradiation with an Embedded Phase II Trial for Patients with a Poor Early Response using Positron Emission Tomography/Computed Tomography. Clin Oncol (R Coll Radiol) 2022; 34:e269-e280. [PMID: 35466013 DOI: 10.1016/j.clon.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022]
Abstract
The SCOPE 2 trial of definitive chemoradiotherapy in oesophageal cancer investigates the benefits of radiotherapy dose escalation and systemic therapy optimisation. The trial opened in 2016. The landscape of oesophageal cancer treatment over the lifetime of this trial has changed significantly and the protocol has evolved to reflect this. However, with the recent results of the Dutch phase III ART DECO study showing no improvement in local control or overall survival with radiotherapy dose escalation in a similar patient group, we sought to determine if the SCOPE 2 trial is still answering the key unanswered questions for oesophageal radiotherapy. Here we discuss the rationale behind the SCOPE 2 trial, outline the trial schema and review current data on dose escalation and outline recommendations for future areas of research.
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Affiliation(s)
- S Bridges
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - B Thomas
- Velindre University NHS Trust, Cardiff, UK.
| | | | - M Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - A Holborow
- South West Wales Cancer Centre, Swansea, UK
| | - C Hurt
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - S Mukherjee
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - L Nixon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Crosby
- Velindre University NHS Trust, Cardiff, UK
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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Chen Y, Huang Q, Chen J, Lin Y, Huang X, Wang Q, Yang Y, Chen B, Ye Y, Zheng B, Qi R, Chen Y, Xu Y. Primary gross tumor volume is prognostic and suggests treatment in upper esophageal cancer. BMC Cancer 2021; 21:1130. [PMID: 34670513 PMCID: PMC8529770 DOI: 10.1186/s12885-021-08838-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
Background To aid clinicians strategizing treatment for upper esophageal squamous cell carcinoma (ESCC), this retrospective study investigated associations between primary gross tumor volume (GTVp) and prognosis in patients given surgical resection, radiotherapy, or both resection and radiotherapy. Methods The population comprised 568 patients with upper ESCC given definitive treatment, including 238, 216, and 114 who underwent surgery, radiotherapy, or combined radiotherapy and surgery. GTVp as a continuous variable was entered into the multivariate Cox model using penalized splines (P-splines) to determine the optimal cutoff value. Propensity score matching (PSM) was used to adjust imbalanced characteristics among the treatment groups. Results P-spline regression revealed a dependence of patient outcomes on GTVp, with 30 cm3 being an optimal cut-off for differences in overall and progression-free survival (OS, PFS). GTVp ≥30 cm3 was a negative independent prognostic factor for OS and PFS. PSM analyses confirmed the prognostic value of GTVp. For GTVp < 30 cm3, no significant survival differences were observed among the 3 treatments. For GTVp ≥30 cm3, the worst 5-year OS rate was experienced by those given surgery. The 5-year PFS rate of patients given combined radiotherapy and surgery was significantly better than that of patients given radiotherapy. The surgical complications of patients given the combined treatment were comparable to those who received surgery, but radiation side effects were significantly lower. Conclusion GTVp is prognostic for OS and PFS in upper ESCC. For patients with GTVp ≥30 cm3, radiotherapy plus surgery was more effective than either treatment alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08838-w.
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Affiliation(s)
- Yuanmei Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Qiuyuan Huang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Junqiang Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China.
| | - Yu Lin
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Xinyi Huang
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Qifeng Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Yang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bijuan Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Yuling Ye
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Binglin Zheng
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Rong Qi
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Yushan Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China
| | - Yuanji Xu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, No. 420, Fuma Road, Fuzhou, 350014, China.
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Fan B, Li C, Mu F, Qin W, Wang L, Sun X, Wang C, Zou B, Wang S, Li W, Hu M. Dose escalation guided by 18F-FDG PET/CT for esophageal cancer. RADIATION MEDICINE AND PROTECTION 2021. [DOI: 10.1016/j.radmp.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Lin FC, Chang WL, Chiang NJ, Lin MY, Chung TJ, Pao TH, Lai WW, Tseng Y, Yen Y, Sheu BS. Radiation dose escalation can improve local disease control and survival among esophageal cancer patients with large primary tumor volume receiving definitive chemoradiotherapy. PLoS One 2020; 15:e0237114. [PMID: 32760099 PMCID: PMC7410311 DOI: 10.1371/journal.pone.0237114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aimed to investigate the correlation between primary tumor volume and cancer failure patterns in esophageal squamous cell carcinoma (ESCC) treated with definitive concurrent chemoradiotherapy (CCRT) and examine whether increasing radiation dose can improve the outcome. METHODS We retrospectively reviewed 124 patients with stage III ESCC treated by definitive CCRT. The primary tumor volume calculated from the radiotherapy planning computed tomography scans was correlated to treatment response, time to disease progression, and overall survival. We further analyzed whether a higher radiation dose correlated with better disease control and patient survival. RESULTS Patients with poor CCRT response had a larger primary tumor volume than those with good response (97.9 vs 64.3 cm3, P = 0.032). The optimal cutoff value to predict CCRT response was 55.3 cm3. Large primary tumor volume (≥ 55.3 cm3) correlated with shorter time to tumor progression in the esophagus (13.6 vs 48.6 months, P = 0.033) compared with small tumor volume (< 55.3 cm3). For the large esophageal tumors (≥ 55.3 cm3), radiation dose > 60 gray significantly prolonged the time to tumor progression in esophagus (20.3 vs 10.1 months, P = 0.036) and overall survival (12.2 vs 8.0 months, P = 0.030), compared with dose ≤ 60 gray. In contrast, higher radiation dose did not benefit local disease control or overall survival in the small esophageal tumors (< 55.3 cm3). CONCLUSION Large primary tumor volume correlates with poor local control and overall survival in ESCC treated with definitive CCRT. Radiation dose > 60 gray can improve the outcomes in patients with large primary tumor. Further prospective dose escalation trials are warranted.
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Affiliation(s)
- Forn-Chia Lin
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Jung Chiang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Meng-Ying Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ta-Jung Chung
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Hui Pao
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yau‐Lin Tseng
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi‐Ting Yen
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bor-Shyang Sheu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Huang R, Guo H, Chen J, Zhai T, Chen J, Lin K, Chen Z, Li D, Chen C. Intratreatment Tumor Volume Change During Definitive Chemoradiotherapy is Predictive for Treatment Outcome of Patients with Esophageal Carcinoma. Cancer Manag Res 2020; 12:7331-7339. [PMID: 32884347 PMCID: PMC7443451 DOI: 10.2147/cmar.s246500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 07/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to assess the predictive value of tumor volume changes of esophagus evaluated by serial computed tomography (CT) scans before, during, and after radical chemoradiotherapy (CRT) for treatment outcomes in patients with esophageal cancer (EC). METHODS Fifty-three patients with histologically confirmed EC were included for analysis. Gross tumor volume of esophagus (GTVe) was manually contoured on the CT images before treatment, at a twentieth fraction of radiotherapy, at completion of CRT and three months after treatment. GTVe reduction ratio (RR) was calculated to reveal changes of tumor volume by time. The Kaplan-Meier method was used to estimate survival and for univariate analysis. The Cox regression model was performed for multivariate analysis. RESULTS Predominant reduction of GTVe was observed during the first 20 fractions of radiotherapy. Age, pretreatment GTVe, GTVe three months after treatment and GTVe RR at twentieth fraction of radiotherapy were all significantly associated with overall survival (OS) in a univariate analysis. Gender was correlated with locoregional recurrence-free survival (LRRFS) in univariate analysis. Multivariate analysis showed that GTVe ≤20 cc, GTVe RR at twentieth fraction of radiotherapy ≥35% were positive predictive factors of OS and pretreatment GTVe ≤20 cc was prognostic for a favorable LRRFS. CONCLUSION Pretreatment tumor volume and intratreatment volume reduction ratio are reliable prognostic factors for esophageal cancer treated with definitive CRT.
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Affiliation(s)
- Ruihong Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
| | - Hong Guo
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
| | - Jianzhou Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, OxfordOX3 7DQ, UK
| | - Tiantian Zhai
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen9700 RB, the Netherlands
| | - Junwei Chen
- Department of Radiology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
| | - Kun Lin
- Department of Health Statistics, Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
| | - Zhijian Chen
- Department of Radiation Oncology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong518053, People’s Republic of China
| | - Derui Li
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
| | - Chuangzhen Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of China
- Correspondence: Chuangzhen Chen; Derui Li Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong515031, People’s Republic of ChinaTel +86 8855 5844 Email ;
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Li T, Fu X, Xiao L, Su L, Dai Y, Yao Q, Li J. The long-term impact of tumor burden in pT3N0M0 esophageal squamous cell carcinoma: A propensity score-matched analysis. Medicine (Baltimore) 2019; 98:e17637. [PMID: 31626150 PMCID: PMC6824748 DOI: 10.1097/md.0000000000017637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to assess the impact of tumor burden on the survival of patients with pathologic T3N0M0 (pT3N0M0) esophageal squamous cell carcinoma (ESCC).A total of 84 patients with pathologic T3N0M0 ESCC treated with radical esophagectomy and 3-field lymphadenectomy (3-FL) from January 2008 to December 2009 in our center were analyzed. Receiver-operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff value. The Kaplan-Meier method and log-rank test were used to assess the overall survival (OS) differences between groups. A regression model was applied to identify prognostic factors for OS. Propensity score matching (PSM) was performed to adjust for the imbalance and indication biases in the 2 groups.The median follow-up time was 62 months (range, 1-84 months), and the 5-year OS rate was 62% (95% confidence interval, 52.2-71.8%). According to the ROC curve analysis, the optimal cutoff values for the maximal esophageal wall thickness, tumor length, and tumor volume were 1.3 cm, 5.9 cm, and 18.6 cc, respectively. Univariate analysis revealed that maximal esophageal wall thickness >1.3 cm (P = .014), tumor volume >18.6 cc (P < .001), and vascular invasion (P < .001) were significantly associated with OS. The multivariate Cox regression model identified tumor volume and vascular invasion as factors affecting OS. After propensity matching, patients with a tumor volume ≤18.6 cc had a better OS than those with a tumor volume >18.6 cc (5-year OS, 85% vs 50%, P = .008).Tumor volume may serve as a good prognostic factor for patients with pT3N0M0 ESCC treated with radical esophagectomy and 3-FL. Larger-scale studies are warranted to validate these findings.
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Affiliation(s)
- Tingting Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou
| | - Xiaobin Fu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Lihua Xiao
- Department of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou
| | - Liyu Su
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yaqing Dai
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Qiwei Yao
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
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12
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Yang Z, He B, Zhuang X, Gao X, Wang D, Li M, Lin Z, Luo R. CT-based radiomic signatures for prediction of pathologic complete response in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy. JOURNAL OF RADIATION RESEARCH 2019; 60:538-545. [PMID: 31111948 PMCID: PMC6640907 DOI: 10.1093/jrr/rrz027] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/18/2019] [Indexed: 02/05/2023]
Abstract
The objective of this study was to build models to predict complete pathologic response (pCR) after neoadjuvant chemoradiotherapy (nCRT) in esophageal squamous cell carcinoma (ESCC) patients using radiomic features. A total of 55 consecutive patients pathologically diagnosed as having ESCC were included in this study. Patients were divided into a training cohort (44 patients) and a testing cohort (11 patients). The logistic regression analysis using likelihood ratio forward selection was performed to select the predictive clinical parameters for pCR, and the least absolute shrinkage and selection operator (LASSO) with logistic regression to select radiomic predictors in the training cohort. Model performance in the training and testing groups was evaluated using the area under the receiver operating characteristic curves (AUC). The multivariate logistic regression analysis identified no clinical predictors for pCR. Thus, only radiomic features selected by LASSO were used to build prediction models. Three logistic regression models for pCR prediction were developed in the training cohort, and they were able to predict pCR well in both the training (AUC, 0.84-0.86) and the testing cohorts (AUC, 0.71-0.79). There were no differences between these AUCs. We developed three predictive models for pCR after nCRT using radiomic parameters and they demonstrated good model performance.
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Affiliation(s)
- Zhining Yang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, China
| | - Binghui He
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, China
- Department of Radiation Oncology, Donghua Hospital Affiliated to Zhongshan University,1 Dongcheng East Road, Dongguan, Guangdong, China
| | - Xinyu Zhuang
- Eye Center, Medical Center—University of Freiburg, Killianstraße, Freiburg Germany
| | - Xiaoying Gao
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, China
| | - Dandan Wang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, China
| | - Mei Li
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, China
| | - Zhixiong Lin
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, Guangdong, China
| | - Ren Luo
- Department of Radiation Oncology, Medical Center—University of Freiburg, Robert-Koch-Str. 3, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Corresponding author. Department of Radiation Oncology, Medical Center—University of Freiburg, Robert-Koch-Str. 3, D-79106 Freiburg, Germany; Faculty of Biology, University of Freiburg, D-79104 Freiburg, Germany. Tel: +49-17645735432; Fax:+49-761 270-95130; ;
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13
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Lin JB, Hung LC, Cheng CY, Chien YA, Lee CH, Huang CC, Chou TW, Ko MH, Lai YC, Liu MT, Chang TH, Lee J, Chen YJ. Prognostic significance of lung radiation dose in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy. Radiat Oncol 2019; 14:85. [PMID: 31126307 PMCID: PMC6534831 DOI: 10.1186/s13014-019-1283-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background The prognostic significance of radiation dose to the lung or heart is unknown in esophageal cancer patients receiving neoadjuvant chemoradiotherapy followed by surgery (trimodal therapy). This study aimed to determine the association between lung and heart radiation dose volumes and prognosis of esophageal cancer after trimodal therapy. Methods This study reviewed 123 esophageal cancer patients treated with trimodal therapy in two tertiary institutions between 2010 and 2015. The dose-volume histogram parameter of Vx was defined as the percentage of total organ volume receiving a radiation dose of x (Gy) or more. Predictors of overall survival (OS) were identified using Cox regression models. Receiver-operating characteristic curves were used to select cut-off values for dose-volume. Results Median follow-up was 28.3 months (range: 4.7–92.8 months). Median OS and progression-free survival were 34.0 months (95% confidence interval [CI]: 27.4–40.6 months) and 24.8 months (95% CI, 18.9–30.7 months), respectively. Multivariate analyses showed that lung V20 (hazard ratio, 1.09; 95% CI: 1.04–1.14; p < 0.001) and lung V5 (hazard ratio, 1.02; 95% CI: 1.00–1.05; p = 0.03) were associated with OS when adjusting for surgical margin and pathological treatment response. The 5-year OS for patients with lung V20 ≤ 23% vs. patients with lung V20 > 23% was 54.4% vs. 5% (p < 0.001) whereas that for patients with lung V5 ≤ 56% vs. patients with lung V5 > 56% was 81.5% vs. 23.4% (p < 0.001). Mean heart dose showed no association with survival outcomes. Conclusions Lung radiation dose was independently associated with survival outcomes in esophageal cancer patients treated with neoadjuvant chemoradiotherapy and surgery. Electronic supplementary material The online version of this article (10.1186/s13014-019-1283-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jhen-Bin Lin
- Department of Radiation Oncology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 50006, Taiwan
| | - Li-Chung Hung
- Department of Radiation Oncology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 50006, Taiwan
| | - Ching-Yuan Cheng
- Department of Thoracic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-An Chien
- Department of Radiation Oncology, Changhua Christian Hospital Yunlin Branch, Yunlin, Taiwan
| | - Chou-Hsien Lee
- Department of Radiation Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Chia-Chun Huang
- Department of Radiation Oncology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 50006, Taiwan
| | - Tsai-Wei Chou
- Department of Radiation Oncology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 50006, Taiwan
| | - Ming-Huei Ko
- Division of Medical Physics, Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yuan-Chun Lai
- Division of Medical Physics, Department of Radiation Oncology, Changhua Christian Hospital, Changhua, Taiwan
| | - Mu-Tai Liu
- Department of Radiation Oncology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 50006, Taiwan.,Department of Medical Imaging and Radiological Technology, Yuanpei University of Science and Technology, Hsinchu, Taiwan
| | - Tung-Hao Chang
- Department of Radiation Oncology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua City, 50006, Taiwan. .,Department of Medical Imaging and Radiological Technology, Yuanpei University of Science and Technology, Hsinchu, Taiwan.
| | - Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, 92, Section 2, Chung Shan North Road, Taipei, 10449, Taiwan. .,Department of Medicine, MacKay Medical College, New Taipei city, Taiwan.
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, 92, Section 2, Chung Shan North Road, Taipei, 10449, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei city, Taiwan
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Lv J, Gan H, Zhang W, Pan L, Wang R, Qin Y. Relative tumor volume is a better independent prognostic factor in esophageal squamous cell carcinoma: Results of a retrospective study. Medicine (Baltimore) 2019; 98:e14963. [PMID: 30946321 PMCID: PMC6456139 DOI: 10.1097/md.0000000000014963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The present study is to evaluate the significance in prognosis of relative tumor volume (RTV) in patients with non-resectable esophageal squamous cell carcinoma (ESCC) treated by definitive radiotherapy alone or in combination with chemotherapy.Fifty-eight consecutive patients with ESCC in UICC stage I to IV were retrospectively analyzed. Relative primary gross volume (RGTVp) was defined as primary gross volume (GTVp) divided by body volume. Relative primary gross volume for lymph nodes (RGTVnd) was defined as primary gross volume for lymph nodes (GTVnd) divided by body volume. The relationships were analyzed between overall survival (OS), disease free survival (DFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and RGTVp (RGTVnd) in univariate and multivariate analyses.The cut-off values of 0.947 and 0.007 were determined for RGTVp and RGTVnd, respectively. The 3-year OS, DFS, and LRFS for patients with RGTVp ≤ 0.947 vs RGTVp > 0.947 was 65.4% vs 25.0% (P = .001), 46.2% vs 12.5% (P = .002), and 90.1% vs 42.0% (P < .001). RGTVp was an independent risk factor for OS (P = .046), DFS (P = .015) and LRFS (P = .032), but showed no association with DMFS in univariate and multivariate analyses. The 3-year DFS and DMFS for patients with RGTVnd ≤ 0.007 vs RGTVnd > 0.007 was 44.4% vs 20.0% (P = .023), and 62.9% vs 24.6% (P < .004). RGTVnd was associated with DMFS (P = .012) in multivariate, but showed no associated with DFS.The present study demonstrates that RTV was an independent factor relevant to prognosis for ESCC. It provides new clinical basis for personalized therapeutic regimens and might be included in the staging system.
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Affiliation(s)
- Jun Lv
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University
- Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning 530021, Guangxi, China
| | - Huimin Gan
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University
- Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning 530021, Guangxi, China
| | - Wei Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University
- Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning 530021, Guangxi, China
| | - Linjiang Pan
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University
- Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning 530021, Guangxi, China
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University
- Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning 530021, Guangxi, China
| | - Yutao Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University
- Radiation Oncology Clinical Medical Research Center of Guangxi, Nanning 530021, Guangxi, China
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Proposed revision of the 8th edition AJCC clinical staging system for esophageal squamous cell cancer treated with definitive chemo-IMRT based on CT imaging. Radiat Oncol 2019; 14:54. [PMID: 30922343 PMCID: PMC6437982 DOI: 10.1186/s13014-019-1258-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/20/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To validate and propose revision of the 8th edition American Joint Committee on Cancer (AJCC) clinical staging system for esophageal squamous cell cancer (ESCC) patients treated with definitive intensity-modulated radiation therapy combined with concurrent chemotherapy (Chemo-IMRT) based on computed tomography (CT) imaging. Methods The clinical data of patients with ESCC treated with Chemo-IMRT were collected and retrospectively reviewed. All CT images were independently reevaluated and restaged according to the 8th edition AJCC staging system. The overall survival (OS) rates were analyzed statistically. ROC curves of the various parameters of the primary tumor and metastatic lymph nodes were generated in order to identify the cutoff values correlated to patient survival using the area under curve. Results The gross tumor volume of the primary tumor (GTV-prT) and the clinical N stage (cN) were independent factors that influenced OS. The 5-year OS rate of patients with GTV-prT ≤28 cm3, GTV-prT > 28 and ≤ 56 cm3, and GTV-prT > 56 cm3 were 54.6, 31.1 and 18.6%, respectively. The 5-year OS rate of patients with cN0, cN1 SLNM (−), cN2 SLNM (−), cN3 SLNM (−) and SLNM (+) were 62.8 (P < 0.001), 34.0 (P = 0.16), 20.0 (P = 0.785), 0 (P < 0.001) and 26.9%, respectively. After restaging the SLNM as regional MLNs, the 5-year OS rates of the patients with cN0, 1, 2 and 3 were 62.8, 36.3, 23.7 and 7.8%, respectively. Various GTV-prT were combined with the cN to establish a new clinical TNM staging system: I, GTV-prT1 and cN0; II, GTV-prT2 or 3 and cN0, GTV-prT1 and cN1; III, GTV-prT1 and cN2, GTV-prT2 and cN1,2; Iva, GTV-prT3 and cN1,2; IVb, GTV-prTany and cN3; IVc, TanyNanyM1. Subsequently, the OS differed significantly between the adjacent GTV-prT cN categories, except those of stage I vs. II. Conclusion The SLNM should be dealt with as a regional rather than a distant disease in patients with ESCC when treated with CRT. The proposed nonsurgical staging system based on the GTV-prT and N appears to be a simple and accurate prognosis predictor for patients with ESCC who have undergone definitive Chemo-IMRT.
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16
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Chen J, Lin Y, Cai W, Su T, Wang B, Li J, Wu J, Pan J, Chen C. A new clinical staging system for esophageal cancer to predict survival after definitive chemoradiation or radiotherapy. Dis Esophagus 2018; 31:5046764. [PMID: 29961898 DOI: 10.1093/dote/doy043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study is to evaluate the prognostic value of a new clinical staging system for esophageal cancer to predict survival after (chemo)radiotherapy. This retrospective study enrolled 444 patients with esophageal squamous cell carcinoma who underwent definitive intensity-modulated radiotherapy with or without chemotherapy between January 2008 and May 2014. A clinical staging system based on the gross tumor volume and maximum diameter of metastatic lymph nodes was developed and the prognostic value of this staging system was compared with that of the 8th edition of American Joint Committee on Cancer TNM staging system. The 3-year survival rate in the whole group was 44.5%. Multivariate analysis showed that gross tumor volume and maximum diameter of metastatic lymph nodes were independent prognostic factors. According to the proposed clinical staging system, the 3-year survival curves of each T, N, and TNM stage were well segregated. On the other hand, 3-year survival rates based on the 8th edition of cTNM staging system were similar between cT3 and cT4, cN1 and cN2, cN2, and cN3, III and IVa stages.The proposed clinical staging system appears to be a simple and accurate predictor of outcome in patients with esophageal squamous cell carcinoma who underwent definitive (chemo) intensity-modulated radiotherapy.
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Affiliation(s)
- J Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - Y Lin
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - W Cai
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, China
| | - T Su
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - B Wang
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - J Li
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - J Wu
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - J Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
| | - C Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou
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17
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Kasangian AA, Gherardi G, Biagioli E, Torri V, Moretti A, Bernardin E, Cordovana A, Farina G, Bramati A, Piva S, Dazzani MC, Paternò E, La Verde NM. The prognostic role of tumor size in early breast cancer in the era of molecular biology. PLoS One 2017; 12:e0189127. [PMID: 29211792 PMCID: PMC5718505 DOI: 10.1371/journal.pone.0189127] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022] Open
Abstract
Background The prognosis of early breast cancer (EBC) depends on patient and tumor characteristics. The association between tumor size, the largest diameter in TNM staging, and prognosis is well recognized. According to TNM, tumors classified as T2, could have very different volumes; e.g. a tumor of 2.1 cm has a volume of 4500 mm3, while a tumor of 4.9 cm has a volume of 60.000 mm3 even belonging to the same class. The aim of the study is to establish if the prognostic role of tumor size, expressed as diameter and volume, has been overshadowed by other factors. Methods The primary objective is to evaluate the association between tumor dimensions and overall survival (OS) / disease free survival (DFS), in our institution from January 1st 2005 to September 30th 2013 in a surgical T1-T2 population. Volume was evaluated with the measurement of three half-diameters of the tumor (a, b and c), and calculated using the following formula: 4/3π x a x b x c. Results 341 patients with T1-T2 EBC were included. 86.5% were treated with conservative surgery. 85.1% had a Luminal subtype, 9.1% were Triple negative and 7.4% were HER2 positive. Median volume was 942 mm3 (range 0.52–31.651.2). 44 patients (12.9%) relapsed and 23 patients died. With a median follow-up of 6.5 years, the univariate analysis for DFS showed an association between age, tumor size, volume, histological grading and molecular subtype. The multivariate analysis confirmed the statistically significant association only for molecular subtype (p 0.005), with a worse prognosis for Triple negative and HER2 positive subtypes compared with Luminal (HR: 2.65; 95%CI: 1.34–5.22). Likewise for OS, an association was shown by the multivariate analysis solely for molecular subtype (HER2 and Triple negative vs. Luminal. HR: 2.83; 95% CI:1.46–5.49; p 0.002). Conclusions In our study, the only parameter that strongly influences survival is molecular subtype. These findings encourage clinicians to choose adjuvant treatment not based on dimensional criteria but on biological features.
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Affiliation(s)
- Anaid Anna Kasangian
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Breast Surgery Unit, Milan, Italy
| | - Giorgio Gherardi
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Pathology, Milan, Italy
| | - Elena Biagioli
- IRCCS—Mario Negri Institute for Pharmacological Research, Milan, Laboratory of Methodology for Biomedical Research, Milan, Italy
| | - Valter Torri
- IRCCS—Mario Negri Institute for Pharmacological Research, Milan, Laboratory of Methodology for Biomedical Research, Milan, Italy
| | - Anna Moretti
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
- * E-mail:
| | - Elena Bernardin
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Breast Surgery Unit, Milan, Italy
| | - Andrea Cordovana
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Breast Surgery Unit, Milan, Italy
| | - Gabriella Farina
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Annalisa Bramati
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Sheila Piva
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Maria Chiara Dazzani
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Emanuela Paternò
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
| | - Nicla Maria La Verde
- ASST Fatebenefratelli Sacco PO Fatebenefratelli Department of Oncology, Milan, Italy
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18
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Chen J, Su T, Lin Y, Wang B, Li J, Pan J, Chen C. Intensity-modulated radiotherapy combined with paclitaxel and platinum treatment regimens in locally advanced esophageal squamous cell carcinoma. Clin Transl Oncol 2017; 20:411-419. [PMID: 28779422 DOI: 10.1007/s12094-017-1734-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 07/28/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE This study was conducted to investigate the efficacy and toxicity of combination treatment with intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy with paclitaxel plus different platinum agents in locally advanced esophageal squamous cell carcinoma (ESCC). METHODS This retrospective study enrolled 242 patients treated with paclitaxel (135 mg/m2) plus platinum regimens. According to the different platinum agents used, patients were classified into: cisplatin 80 mg/m2 (CP), nidaplatinum 80 mg/m2 (NP), lobaplatin 35 mg/m2 (LP), and oxaliplatin 135 mg m2 (OP) groups, and survival and toxicity rates between the four groups were compared. The median overall survival (OS) was 31.1 months. RESULTS No significant differences were observed among the CP, NP, LP, and OP groups with regard to 3-year survival rates (46.2, 56.4, 45.7, and 29.0%, respectively). A stratified analysis indicated that 3-year survival rates were significantly lower in the OP group. Renal toxicities and gastrointestinal reactions were more frequent in the CP group than in the other three groups. Three-year survival rates were similar among patients receiving 2, 3, or ≥4 cycles of chemotherapy (40.1, 49.5, and 50.8%, respectively). Multivariate analysis indicated that tumor volume and maximum diameter of metastatic lymph nodes might be independent prognostic factors. CONCLUSION Paclitaxel plus nidaplatinum or lobaplatin is recommended in locally advanced ESCC due to their satisfying therapeutic effects and less toxicity. Tumor volume and maximum diameter of metastatic lymph nodes are independent prognostic factors in ESCC patients receiving IMRT and concurrent chemotherapy.
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Affiliation(s)
- J Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China.
| | - T Su
- Department of Oncology, Huadu District People's Hospital, Guangzhou, 510000, Guangdong, China
| | - Y Lin
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - B Wang
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - J Li
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - J Pan
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - C Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
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Wang Q, Zhou S, Court LE, Verma V, Koay EJ, Zhang L, Zhang W, Tang C, Lin S, Welsh JD, Blum M, Betancourt S, Maru D, Hofstetter WL, Chang JY. Radiomics predicts clinical outcome in primary gastroesophageal junction adenocarcinoma treated by chemo/radiotherapy and surgery. Phys Imaging Radiat Oncol 2017. [DOI: 10.1016/j.phro.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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20
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Beukinga RJ, Hulshoff JB, van Dijk LV, Muijs CT, Burgerhof JGM, Kats-Ugurlu G, Slart RHJA, Slump CH, Mul VEM, Plukker JTM. Predicting Response to Neoadjuvant Chemoradiotherapy in Esophageal Cancer with Textural Features Derived from Pretreatment 18F-FDG PET/CT Imaging. J Nucl Med 2016; 58:723-729. [PMID: 27738011 DOI: 10.2967/jnumed.116.180299] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022] Open
Abstract
Adequate prediction of tumor response to neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer (EC) patients is important in a more personalized treatment. The current best clinical method to predict pathologic complete response is SUVmax in 18F-FDG PET/CT imaging. To improve the prediction of response, we constructed a model to predict complete response to nCRT in EC based on pretreatment clinical parameters and 18F-FDG PET/CT-derived textural features. Methods: From a prospectively maintained single-institution database, we reviewed 97 consecutive patients with locally advanced EC and a pretreatment 18F-FDG PET/CT scan between 2009 and 2015. All patients were treated with nCRT (carboplatin/paclitaxel/41.4 Gy) followed by esophagectomy. We analyzed clinical, geometric, and pretreatment textural features extracted from both 18F-FDG PET and CT. The current most accurate prediction model with SUVmax as a predictor variable was compared with 6 different response prediction models constructed using least absolute shrinkage and selection operator regularized logistic regression. Internal validation was performed to estimate the model's performances. Pathologic response was defined as complete versus incomplete response (Mandard tumor regression grade system 1 vs. 2-5). Results: Pathologic examination revealed 19 (19.6%) complete and 78 (80.4%) incomplete responders. Least absolute shrinkage and selection operator regularization selected the clinical parameters: histologic type and clinical T stage, the 18F-FDG PET-derived textural feature long run low gray level emphasis, and the CT-derived textural feature run percentage. Introducing these variables to a logistic regression analysis showed areas under the receiver-operating-characteristic curve (AUCs) of 0.78 compared with 0.58 in the SUVmax model. The discrimination slopes were 0.17 compared with 0.01, respectively. After internal validation, the AUCs decreased to 0.74 and 0.54, respectively. Conclusion: The predictive values of the constructed models were superior to the standard method (SUVmax). These results can be considered as an initial step in predicting tumor response to nCRT in locally advanced EC. Further research in refining the predictive value of these models is needed to justify omission of surgery.
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Affiliation(s)
- Roelof J Beukinga
- Department of Surgery (Division of Surgical Oncology), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Jan B Hulshoff
- Department of Surgery (Division of Surgical Oncology), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gursah Kats-Ugurlu
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Véronique E M Mul
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John Th M Plukker
- Department of Surgery (Division of Surgical Oncology), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Tullie LGC, Sohn HM, Zylstra J, Mattsson F, Griffin N, Sharma N, Porté F, Ramage L, Cook GJ, Gossage JA, Mason RC, Lagergren J, Davies AR. A Role for Tumor Volume Assessment in Resectable Esophageal Cancer. Ann Surg Oncol 2016; 23:3063-70. [PMID: 27112584 DOI: 10.1245/s10434-016-5228-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Esophageal cancer has a poor prognosis, and many patients undergoing surgery have a low chance of cure. Imaging studies suggest that tumor volume is prognostic. The study aimed to evaluate pathological tumor volume (PTV) as a prognostic variable in esophageal cancer. METHODS This single-center cohort study included 283 patients who underwent esophageal cancer resections between 2000 and 2012. PTVs were obtained from pathological measurements using a validated volume formula. The prognostic value of PTV was analyzed using multivariable regression models, adjusting for age, tumor grade, tumor (T) stage, nodal stage, lymphovascular invasion, resection margin, resection type, and chemotherapy response, which provided hazard ratios (HRs) with 95 % confidence intervals (CIs). Primary outcomes were time to death and time to recurrence. Secondary outcomes were margin involvement and lymph node positivity. Correlation analysis was performed between imaging and PTVs. RESULTS On unadjusted analysis, increasing PTV was associated with worse overall mortality (HR 2.30, 95 % CI 1.41-3.73) and disease recurrence (HR 1.87, 95 % CI 1.14-3.07). Adjusted analysis demonstrated worse overall mortality with increasing PTV but reached significance in only one subgroup (HR 1.70, 95 % CI 1.09-2.38). PTV was an independent predictor of margin involvement (OR 2.28, 95 % CI 1.02-5.13) and lymph node-positive status (OR 2.77, 95 % CI 1.23-6.28). Correlation analyses demonstrated significant positive correlation between computed tomography (CT) software and formula tumor volumes (r = 0.927, p < 0.0001), CT and positron emission tomography tumor volumes (r = 0.547, p < 0.0001), and CT and PTVs (r = 0.310, p < 0.001). CONCLUSIONS Tumor volume may predict survival, margin status, and lymph node positivity after surgery for esophageal cancer.
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Affiliation(s)
- Lucinda G C Tullie
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.
| | - Hyon-Mok Sohn
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
| | - Janine Zylstra
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Nyree Griffin
- Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
| | - Naveen Sharma
- Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
| | - Francois Porté
- Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
| | - Lisa Ramage
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
| | - Gary J Cook
- Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
| | - James A Gossage
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Robert C Mason
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Lagergren
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Andrew R Davies
- Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK
- Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Chen Y, Zhang Z, Jiang G, Zhao K. Gross tumor volume is the prognostic factor for squamous cell esophageal cancer patients treated with definitive radiotherapy. J Thorac Dis 2016; 8:1155-61. [PMID: 27293832 DOI: 10.21037/jtd.2016.04.08] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND To investigate whether gross tumor volume (GTV) defined on radiotherapy planning scans a prognostic factor for esophageal squamous cell carcinoma (ESCC) patients treated with definitive radiotherapy. METHODS From 2008 to 2011, 187 ESCC patients who were treated with definitive radio(chemo)therapy were analyzed retrospectively. Tumor volumes such as GTV, gross tumor volume of primary esophageal cancer (GTV-P), and gross tumor volume of metastases lymph nodes (GTV-N) were computed by Philips Healthcare radiation therapy planning system (Pinnacle 8.0). Kaplan-Meier cumulative probability and Cox proportional hazards regression models were used to assess the effect of the clinical factors along with tumor volume on progression-free survival (PFS) and overall survival (OS). RESULTS In the univariate analysis, fraction dose, TNM stage, total radiation dose, GTV, GTV-P, and GTV-N were all significantly associated with both OS and PFS (P<0.05). While in multivariate analysis, GTV and fraction dose were significantly associated with both OS and PFS (adjusted P<0.05) with adjustment for age, sex, smoking status, chemotherapy, fraction dose, GTV, and radiation dose. CONCLUSIONS GTV may serve as a good prognostic factor for ESCC patients treated with definitive radiotherapy. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Yun Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Guoliang Jiang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Kuaile Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai 200032, China
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23
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Yamashita H, Takenaka R, Okuma K, Ootomo K, Nakagawa K. Prognostic factors in patients after definitive chemoradiation using involved-field radiotherapy for esophageal cancer in a phase II study. Thorac Cancer 2016; 7:564-569. [PMID: 27766787 PMCID: PMC5129562 DOI: 10.1111/1759-7714.12369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/01/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A prospective study was performed on the use of chemoradiotherapy (CRT) for esophageal cancer (EC) with involved-field radiation therapy (IFRT), based on 18-fluorodeoxyglucose positron-emission tomography. Prognostic factors for overall survival (OS) were analyzed. METHODS Eligible patients included 63 adults with newly diagnosed, untreated, inoperable stage I-IV EC with lymph node metastases. Patients received 80 mg/m2 nedaplatin per day on day 1, 800 mg/m2 5-fluorouracil on days 1-4 intravenously repeated every 28 days for two to four cycles, and combined IFRT. Irradiation was applied only to the primary tumor and positive lymph nodes. RESULTS Three-year progression-free survival and OS rates were 44.9% and 47.5%, respectively. The median survival time was 31.5 months. In univariate analyses for OS, Karnofsy Performance Scale <90% (P = 0.027), initial stage (P = 0.0087), T stage (P = 0.066), N stage (P = 0.000086), M stage of M1 (P = 0.0042), dysphagia score (P = 0.00017), tumor marker squamous cell carcinoma antigen >1.5 ng/mL (P = 0.0054), gross tumor volume (GTV) > 60 cc (P = 0.00011), and relative dose intensity (RDI) of chemotherapy ≤50% (P = 0.063) were found to be associated with significantly or marginally worse OS. In multivariate analyses for OS, GTV ≥ 60 cc (P = 0.00040), RDI < 50% (P = 0.00034), and cN2-3 (P = 0.0020) were associated with significantly worse OS. CONCLUSION GTV, RDI and N grading, were associated with OS after definitive CRT using IFRT for EC.
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Affiliation(s)
| | | | - Kae Okuma
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Kuni Ootomo
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
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Wen J, Ye F, Huang X, Li S, Yang L, Xiao X, Xie X. The tumor-to-breast volume ratio (TBR) predicts cancer-specific survival in breast cancer patients who underwent modified radical mastectomy. Tumour Biol 2015; 37:7493-500. [PMID: 26678892 DOI: 10.1007/s13277-015-4382-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022] Open
Abstract
Breast cancer is the most common cancer in women globally, and tumor size measured as the largest diameter of the tumor focus is currently used in tumor-lymph node-metastasis (TNM) staging for prognosis and treatment decisions. The present study utilized the tumor-to-breast volume ratio (TBR) to evaluate the relative tumor size and determined the prognostic impact of TBR on survival in patients with breast cancer. Two thousand twenty-five consecutive breast cancer patients who underwent modified radical mastectomy between January 2002 and December 2008 at Sun Yat-Sen University Cancer Center were enrolled in this retrospective study. Kaplan-Meier analysis was used to assess the prognostic effect of TBR on cancer-specific survival (CSS), and univariate log-rank test and multivariate Cox proportional hazards regression model were performed to identify independent prognostic factors. The optimal cutoff value of TBR was determined to be 1.70 %, and 1473 and 552 patients were categorized to low-TBR and high-TBR groups, respectively. In the whole patient cohort, CSS was significantly shorter in the high-TBR group (110.2 vs 128.5 months, P < 0.001). Univariate and multivariate analyses revealed that TBR was an independent prognostic factor of CSS in breast cancer patients (hazard ratio (HR) 1.489, 95 % CI 1.130-1.961, P = 0.005). High TBR was independently associated with poor prognosis in breast cancer patients. This variable may serve as a valuable parameter to predict the outcomes of breast cancer.
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Affiliation(s)
- Jiahuai Wen
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Feng Ye
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Xiaojia Huang
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Shuaijie Li
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Lu Yang
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Xiangsheng Xiao
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China
| | - Xiaoming Xie
- Department of Breast Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 East Dongfeng Road, Guangzhou, 510060, People's Republic of China.
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