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Liu R, Zhang X, Zhang Q, Luo H, Wei S, Liu T, Sun S, Liu Z, Li Z, Tian J, Wang X. Adjuvant Radiotherapy of Involved Field versus Elective Lymph Node in Patients with Operable Esophageal Squamous Cell Cancer: A Single Institution Prospective Randomized Controlled Study. J Cancer 2021; 12:3180-3189. [PMID: 33976727 PMCID: PMC8100799 DOI: 10.7150/jca.50108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 02/03/2021] [Indexed: 01/04/2023] Open
Abstract
Background: To evaluate locoregional failure and its impact on survival by comparing involved field irradiation (IFI) with elective lymph node irradiation (ENI) for patients with esophageal squamous cell cancer who underwent post-operative radiotherapy. Methods and Materials: The enrolled patients were randomized allocated to IFI or ENI group. CTV of IFI was generated according to pre-operative primary tumor location and post-operative pathological characters and positive LNs regions. CTV of ENI was generated according to pre-operative tumor position to administer selective lymph node irradiation. Radiotherapy planning was delivered using either 3D-CRT or IMRT. Results: A total of 57 patients were enrolled, 28 patients in ENI group and 29 patients in IFI group. There were not statistical differences between two groups in baseline (p>0.05). The initial locoregional failure rate was 17.9 % in ENI arm and 20.7% in IFI arm respectively (p=0.085). The 1-, 3-, and 5-year Progression-free Survival (PFS) were 63.2, 43.5, and 21.8 % in ENI arm versus 78.2, 60.1, and 55.1% in IFI arm (p =0.038). The 1-, 3-, and 5-year overall survival (OS) were 78.6, 46.9, and 23.5 % in ENI arm versus 72.9, 59.7, and 54.3 % in IFI arm (p=0.06). Acute radiation pneumonitis (p=0.005) and hematological toxicities (p =0.029) also showed statistical differences between groups, ENI arm was more than IFI arm. Conclusions: The results indicated that IFI tended to improve survival and reduce toxicities for patients with operative ESCC and did not increase locoregional failure compared to ENI. It is thus suggested that IFI for ESCC PORT is worthy of clinical recommendation and further study.
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Affiliation(s)
- Ruifeng Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
| | - Xueliang Zhang
- Gansu Provincial Cancer Hospital, Lanzhou R.P China, 730050
| | - Qiuning Zhang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
| | - Hongtao Luo
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
| | - Shihong Wei
- Gansu Provincial Cancer Hospital, Lanzhou R.P China, 730050
| | - Tingting Liu
- Gansu Provincial Cancer Hospital, Lanzhou R.P China, 730050
| | - Shilong Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
| | - Zhiqiang Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
| | - Zheng Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
| | - Jinhui Tian
- Center of Evidence Based Medicine, Lanzhou University, Lanzhou R.P China, 730000
| | - Xiaohu Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou R.P China, 730000.,Lanzhou Heavy Ion Hospital, Lanzhou R.P China, 730000.,University of Chinese Academy of Sciences, Beijing R.P China, 100049
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Hagens ERC, van Berge Henegouwen MI, Gisbertz SS. Distribution of Lymph Node Metastases in Esophageal Carcinoma Patients Undergoing Upfront Surgery: A Systematic Review. Cancers (Basel) 2020; 12:cancers12061592. [PMID: 32560226 PMCID: PMC7352338 DOI: 10.3390/cancers12061592] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Metastatic lymphatic mapping in esophageal cancer is important to determine the optimal extent of the radiation field in case of neoadjuvant chemoradiotherapy and lymphadenectomy when esophagectomy is indicated. The objective of this review is to identify the distribution pattern of metastatic lymphatic spread in relation to histology, tumor location, and T-stage in patients with esophageal cancer. Embase and Medline databases were searched by two independent researchers. Studies were included if published before July 2019 and if a transthoracic esophagectomy with a complete 2- or 3-field lymphadenectomy was performed without neoadjuvant therapy. The prevalence of lymph node metastases was described per histologic subtype and primary tumor location. Fourteen studies were included in this review with a total of 8952 patients. We found that both squamous cell carcinoma and adenocarcinoma metastasize to cervical, thoracic, and abdominal lymph node stations, regardless of the primary tumor location. In patients with an upper, middle, and lower thoracic squamous cell carcinoma, the lymph nodes along the right recurrent nerve are often affected (34%, 24% and 10%, respectively). Few studies describe the metastatic pattern of adenocarcinoma. The current literature is heterogeneous in the classification and reporting of lymph node metastases. This complicates evidence-based strategies in neoadjuvant and surgical treatment.
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Vošmik M, Hodek M, Buka D, Sýkorová P, Grepl J, Paluska P, Paulíková S, Sirák I. Cardiotoxicity of radiation therapy in esophageal cancer. Rep Pract Oncol Radiother 2020; 25:318-322. [PMID: 32194352 DOI: 10.1016/j.rpor.2020.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 01/22/2020] [Accepted: 02/19/2020] [Indexed: 12/11/2022] Open
Abstract
With a development of radiotherapeutic techniques, availability of radiotherapy data on cardiotoxicity, and slowly improving esophageal cancer outcomes, an increasing emphasis is placed on the heart protection in radiation treated esophageal cancer patients. Radiation induced heart complications encompass mainly pericardial disease, cardiomyopathy, coronary artery atherosclerosis, valvular heart disease, and arrhythmias. The most frequent toxicity is pericardial effusion which is usually asymptomatic in the majority of patients. The use of modern radiotherapy techniques is expected to reduce the risk of cardiotoxicity, although this expectation has to be confirmed by clinical data.
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Affiliation(s)
- Milan Vošmik
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Miroslav Hodek
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - David Buka
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Petra Sýkorová
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Jakub Grepl
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Petr Paluska
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Simona Paulíková
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
| | - Igor Sirák
- Department of Oncology and Radiotherapy, University Hospital Hradec Kralove, Czech Republic
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Cameniţă D, Demetrian AD, Pleşea RM, Tănasie-Vasile MI, Strâmbu VDE, Grigorean VT, Ioniţă E, Pleşea IE, Marincaş AM. Clinical-morphological profiles of esophageal carcinoma's main types. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2020; 61:407-422. [PMID: 33544792 PMCID: PMC7864308 DOI: 10.47162/rjme.61.2.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aim: The purpose of the study was to define and then to compare particularly the morphological profiles of the main morphological types of esophageal carcinoma (EC). Patients, Materials and Methods: The studied group included 46 operated EC patients. Few parameters were clinical (gender and age). The rest of them described both gross and histological features of the entire group and of the two main histological types of carcinoma (lesion’ site, lateral extension, lesion dimensions, gross aspect, and histological type, and tumor grade, and stage). Stratification scales of cases were defined according to each parameter in order to compare the data and a statistical apparatus [Student’s t-test and χ2 (chi-squared) test] was used. Results: The studied tumors were encountered mostly in mature adult and elderly men, usually in the lower segments of the esophagus. Many of them had between five and ten cm in the long diameter and produced stenosis. Most of them had infiltrating appearance combined often with protruding or/and ulcerated aspects. Usually, the tumors were poorly differentiated and in stage III. The two main histological types of EC showed different morphological profiles. Data from the literature revealed sometimes wide ranges of variation for the studied morphological parameters. Our results were within these ranges of variation. Conclusions: ECs proved to be aggressive and late diagnosed tumors in general, with distinct morphological and behavioral profiles for the two main histological types. Comparisons with literature data confirmed many of our observations regarding the clinical and morphological aspects of both ECs as a whole and its histological types.
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Affiliation(s)
- Dan Cameniţă
- Department II - Morphological Sciences, Carol Davila University of Medicine and Pharmacy, Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania;
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Zhao L, Zhou Y, Mu Y, Chai G, Xiao F, Tan L, Lin SH, Shi M. Patterns of failure and clinical outcomes of definitive radiotherapy for cervical esophageal cancer. Oncotarget 2017; 8:21852-21860. [PMID: 28423530 PMCID: PMC5400628 DOI: 10.18632/oncotarget.15665] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 01/29/2017] [Indexed: 01/12/2023] Open
Abstract
Purpose Because of the scarcity of cervical esophageal cancer (CEC), data for this disease entity is limited. We aim to evaluate the outcomes, prognostic factors and failure patterns of CEC treated by contemporary radiotherapy (RT). Methods We retrospectively analyzed 86 CEC patients consecutively treated between 2007 and 2015 by definitive RT with or without concurrent chemotherapy. RT was mainly delivered with Intensity Modulated Irradiation Therapy (IMRT) or Volumetric-Modulated Arc Therapy (VMAT). Statistical analyses were performed on survival, prognostic factors and failure patterns. Results The median follow-up time was 19.4 months. The 3-year overall survival (OS), local regional failure free survival (LRFFS), distant metastatic free survival (DMFS), and progression free survival (PFS) were 53.6%, 57.9%, 81.5% and 41.5%, respectively. Independent predictors for poorer OS were N stage, hoarseness and recurrent laryngeal nerve lymph node (RLN) involvement, and predictors for LRFFS were N stage and EQD2 (equivalent dose in 2 Gy fraction) to gross tumor volume (GTV), with ≥ 66Gy achieving local control of 94.7%. Patients receiving elective nodal irradiation (ENI) had better nodal regional control than those receiving involved field irradiation (IFI). 31 (36%) patients had treatment failure and 15 (17.4%), 8 (9.3%) and 14 (16.2%) patients had local, regional, and distant failure, respectively. 86.7% (13/15) local failures were within GTV, and supraclavicular region (62.5%, 5/8) was the most common regional failure site. No severe toxicities were observed. Conclusions Our results seem to indicate that good locoregional control might be achieved for CEC with adequate radiation dose and treatment planning approaches.
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Affiliation(s)
- Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
| | - Yongchun Zhou
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
| | - Yunfeng Mu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
| | - Guangjin Chai
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
| | - Feng Xiao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
| | - Lina Tan
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032 China
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