ISSN: 1859 - 2872
Preliminary outcomes of neoadjuvant chemoradiotherapy with four-dimensional volumetric-modulated arc therapy for Vietnamese patients with stage II and III thoracic esophageal cancer
Main Article Content
Keywords
Abstract
Objective: To retrospectively evaluate the preliminary clinical outcomes of neoadjuvant chemoradiotherapy (NACRT) followed by surgery for resectable locally advanced squamous cell esophageal cancer (LA-ESCC). Subject and method: Twenty-two patients who met with criteria were analyzed. The chemotherapeutic regimen was weekly carboplatin plus paclitaxel. We used the Deep Inhale Breath-Hold Volumetric-Modulated Arc Therapy (DIBH-VMAT) technique. The dose prescription was 41.4Gy in 23 fractions, and the irradiation field included the primary tumor, metastatic lymph nodes, and elective regional nodal area. Surgery was planned 4-8 weeks after completion of NACRT, with a right transthoraco-abodminal esophagectomy plus two-filed LN dissection. Result: The median follow-up time was 17.4 months (4.5-43.8 months). All patients completed the planned NACRT and surgery. Regarding the NACRT toxicities, the grade 3 lymphopenia was observed in 2 (9.1%) patients. Regarding the postoperative complications, two (9.1%) patients suffered anastomotic leakage, and two (9.1%) suffered anastomotic stenosis. There was no grade 4-5 acute toxicity. Fourteen (63.6%) patients showed a pathologically complete response, and all patients achieved R0 resection. Four patients had a recurrence at the marginal area of the irradiation field. But these were well controlled by re-irradiation. The mean overall survival was 21.1 months. The 1-, 2-, and 3-year overall survival rates were 95.2%, 95.2%, and 83.3%, and the 1-, 2- and 3-year loco-regional progression-free survivals were 89.9%, 75.6%, and 54.0%, respectively. Conclusion: NACRT with DIBH-VMAT in Vietnamese patients with stage II-III esophageal cancer showed a high completion rate and acceptable toxicity. Response rates were also excellent. Efficacy for survival requires long-term follow-up and further analysis in more patients.
Article Details
References
2. Berger AC, Farma J, Scott WJ et al (2005) Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol 23(19): 4330-4337.
3. Berry MF (2014) Esophageal cancer: staging system and guidelines for staging and treatment. J Thorac Dis 6(3): 289-297.
4. Eyck BM, Lanschot JJB, Hulshof MCCM et al (2021) Ten-Year Outcome of Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer: The Randomized Controlled CROSS trial. J Clin Oncol 39(18): 1995-2004. doi:10.1200/JCO. 20.03614
5. Gebski V, Burmeister B, Smithers BM et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8: 226-234.
6. Gong G, Wang R, Guo Y et al (2013) Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH. Radiat Oncol 20(8): 291.
7. Kloft M, Ruisch JE, Raghuram G et al (2021) Prognostic significance of negative lymph node long axis in esophageal cancer: Results from the randomized controlled UK MRC OE02 Trial. Ann Surg.
8. Low DE, Allum W, De Manzoni G et al (2019) Guidelines for perioperative care in esophagectomy: Enhanced recovery after surgery (ERAS®) Society recommendations. World J Surg 43, 299-330 (2019).
9. Mageras GS, Yorke E (2004) Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment. Semin Radiat Oncol 14(1): 65-75. doi: 10.1053/j. semradonc.2003.10.009. PMID: 14752734.
10. NCCN Guidelines Version 4.2022 Esophageal and Esophagogastric Junction Cancers.
11. Shapiro J, van Lanschot JJB, Hulshof MCCM et al (2015) CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 16(9): 1090-1098.
12. Shewalkar BK, Boralkar AK, Kaldate A et al (2022) A Comparison between neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy in treating esophageal carcinoma: A Study at a tertiary care cancer center in Suburban India. Cureus 14(7): 26674.
13. Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12: 681-692.
14. Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71(3): 209-249.
15. The Global Cancer Observatory , March, 2021. https: //gco.iarc.fr/today/data/factsheets/ populations/704-viet-nam-fact-sheets.pdf .
16. Hagen P, Hulshof MC, van Lanschot JJ et al (2012) CROSS Group. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22): 2074-204. doi: 10.1056/NEJMoa1112088. PMID: 22646630.
17. Yamashita H, Kida S, Sakumi A et al (2011) Four-dimensional measurement of the displacement of internal fiducial markers during 320-multislice computed tomography scanning of thoracic esophageal cancer. Int J Radiat Oncol Biol Phys. 79(2):588-589.
Article Sidebar
