[an error occurred while processing this directive] | [an error occurred while processing this directive]
Relationship between adjuvant radiotherapy dose and pathologic complete response in patients with locally advanced esophageal squamous cell cancer
Zeng Xiaoxiao1,4, Sun Hongna1, Wei Hao1, Xu Yong1, Zhou Xiaojuan1, Ding Zhenyu2, Gong Youling1, Wang Jin1, Zhou Lin1, Lu You1, Yuan Yong3, Hu Yang3, Liu Yongmei1
1 Department of Thoracic Cancer, WestChina Hospital, Sichuan University, Chengdu 610041, China; 2 Department of Biotherapy, WestChina Hospital, Sichuan University, Chengdu 610041, China; 3 Department of Thoracic Surgery, WestChina Hospital, Sichuan University, Chengdu 610041, China; 4 Department of Oncology Ⅱ, Jianyang People's Hospital, Jianyan 641400, China
AbstractObjective To investigate the relationship between the dose of preoperative neoadjuvant radiotherapy and the pathologic complete response (pCR) rate in patients with locally advanced squamous cell esophageal cancer (ESCC). Methods Clinical data of 116 patients with ESCC who received neoadjuvant chemoradiotherapy followed by esophagectomy in our cancer center from July 2017 to December 2019 were retrospectively analyzed. The radiation doses were divided into 2 ranges based on Grays (Gy) received:40-45 Gy and 45 Gy or more. Results The overall pCR rate was 38. 8%(45/116). pCR was observed in 35 out of 80(44%) patients treated with 40-45 Gy and 10 of 36(28%) patients treated with 45 Gy or more. The pCR rate did not significantly differ between two groups [(40-45 Gy) vs.( ≥ 45 Gy), P=0.105)]. Conclusions Preoperative neoadjuvant radiotherapy with a higher dose (≥ 45 Gy) fails to increase the pCR rate in patients with locally advanced ESCC. Prospective randomized trials are required to determine the optimal dose of preoperative adjuvant radiotherapy.
Fund:Health Commission of Sichuan Province（16ZD005）
Corresponding Authors:
Liu Yongmei, Email:lymi75@163.com
Cite this article:
Zeng Xiaoxiao,Sun Hongna,Wei Hao et al. Relationship between adjuvant radiotherapy dose and pathologic complete response in patients with locally advanced esophageal squamous cell cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 644-648.
Zeng Xiaoxiao,Sun Hongna,Wei Hao et al. Relationship between adjuvant radiotherapy dose and pathologic complete response in patients with locally advanced esophageal squamous cell cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 644-648.
[1] 张思维,郑荣寿,左婷婷,等. 中国食管癌死亡状况和生存分析[J]. 中华肿瘤杂志, 2016, 38(9):709-715. DOI:10.3760/cma.j.issn.0253-3766.2016.09.014
[2] Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma[J]. N Engl J Med, 1996, 335:462-467. DOI:10.1056/NEJM199608153350702.
[3] Cao XF, He XT, Ji L, et al. Effects of neoadjuvant radiochemotherapy on pathological staging and prognosis for locally advanced esophageal squamous cell carcinoma[J]. Dis Esophagus, 2009, 22(6):477-481. DOI:10.1111/j.1442-2050.2008.00910.x.
[4] Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase Ⅲ trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer:CALGB 9781[J]. J Clin Oncol, 2008, 26(7):1086-1092. DOI:10.1200/JCO.2007.12.9593.
[5] Van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J]. N Engl J Med, 2012, 366(22):2074-2084. DOI:10.1056/NEJMoa1112088.
[6] Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010):A phase Ⅲ multicenter randomized, open-label clinical trial[J]. J Clin Oncol, 2018, 36(27):2796-2803. DOI:10.1200/JCO.2018.79.1483.
[7] Fakhrian, K, Ordu, AD, Lordick, F, et al. Long-term outcomes of trimodality treatment for squamous cell carcinoma of the esophagus with cisplatin and/or 5-FU:more than 20 years' experience at a single institution.[J]. Strahlenther Onkol, 2014, 190(12):1133-1140. DOI:10.1007/s00066-014-0711-4.
[8] Berger AC, Farma J, Scott WJ, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival[J]. J Clin Oncol, 2005, 23(19):4330-4337. DOI:10.1200/JCO.2005.05.017.
[9] Murphy MB, Xiao L, Patel VR, et al. Pathological complete response in patients with esophageal cancer after the trimodality approach:the association with baseline variables and survival. The University of Texas MD Anderson Cancer Center experience[J]. Cancer, 2017, 123(21):4106-4113. DOI:10.1002/cncr.30953.
[10] Singla S, Gabriel E, Alnaji R, et al. Complete pathologic response is independent of the timing of esophagectomy following neoadjuvant chemoradiation for esophageal cancer[J]. J Gastrointest Oncol, 2018, 9(1):73-79. DOI:10.21037/jgo.2017.09.11.
[11] National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology, esophageal and esophagogastric junction cancers, 2019[DB/OL][2020-02-27]. http://www.nccn.org/patients.
[12] 中国医师协会放射肿瘤治疗医师分会, 中华医学会放射肿瘤治疗学分会, 中国抗癌协会肿瘤放射治疗专业委员会. 中国食管癌放射治疗指南(2019年版)[J]. 国际肿瘤学杂志,2019,46(7):385-398. DOI:10.3760/cma.j.issn.1673-422X.2019.07.001.
Branch of Radiation Oncologists of Chinese Physician Association, Branch of Radiation Oncology of Chinese Medical Association, Cancer Radiotherapy Committee of China Anti Cancer Association. China esophageal cancer radiotherapy guidelines (2019 version)[J]. Int J Oncol, 2019,46(7):385-398. DOI:10.3760/cma.j.issn.1673-422x.2019.07.001.
[13] Ordu AD, Nieder C, Geninitz H, et al. Association between radiation dose and pathologic complete response after preoperative radiochemotherapy in esophageal squamous cell cancer[J]. Anticancer Res, 2014, 34(12):7255-7261.
[14] Worrell SG, Towe CW, Dorth J, et al. Higher doses of neoadjuvant radiation for esophageal cancer do not affect the pathologic complete response rate or survival:a propensity-matched analysis[J]. Ann Surg Oncol, 2020, 27(2):500-508. DOI:10.1245/s10434-019-07849-z.
[15] Shi C, Berlin J, Branton PA, et al. Protocol for the examination of specimens from patients with carcinoma of the esophagus. College of American Pathologists Cancer Protocols, 2017[DB/OL][2019-02-28].http://www.cap.org.
[16] Radiation Therapy Oncology Group. A phase Ⅲ trial evaluating the addition of trastuzumab to trimodality treatment of HER2:overexpressing esophageal adenocarcinoma[DB/OL][2020-02-27]. https://clinicaltrials. gov/ct2/show/NCT01196390?term=RTOG?1010&rank=1.
[17] Cancer and Leukemia Group B, National Cancer Institute. PET scan imaging in assessing response in patients with esophageal cancer receiving combination chemotherapy[DB/OL][2020-02-27]. http://clinicaltrials. gov/show/NCT01333033.
[18] Szumilo J, Chibowski D, Dbrowski A. Assessment of the predictive value of clinical and histopathological factors as well as the immunodepression of p53 and bcl-2 proteins in response to preoperative chemotherapy for esophageal squamous cell carcinoma[J]. Dis esophagus, 2000, 13(3):191-197. DOI:10.1046/j.1442-2050.2000.00110.x.
[19] Huang RW, Chao YK, Wen YW. et al. Predictors of pathological complete response to neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma[J]. World J Surg Oncol, 2014, 12(5):170. DOI:10.1186/1477-7819-12-170.
[20] Hamai Y, Hihara J, Taomoto J. et al. Hemoglobin level influences tumor response and survival after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma[J]. World J Surg, 2014, 38(8):2046-2051. DOI:10.1007/s00268-014-2486-2.
[21] Donahue JM, Nichols FC, Li Z, et al. Complete pathologic response after neoadjuvant chemo-radiotherapy for esophageal cancer is associated with enhanced survival[J]. Ann Thorac Surg, 2009, 87(2):392-398. DOI:10.1016/j.athoracsur.2008.11.001.
[22] Kathiravetpillai N, Koeter M, van der Sangen MJ, et al. Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with esophageal adenocarcinoma[J]. Eur J Surg Oncol, 2016, 42(8):1183-1190. DOI:10.1016/j.ejso.2016.03.033.
[23] Venkat PS, Shridhar R, Naghavi AO, et al. Dose-escalated neoadjuvant chemoradiotherapy with dose-painting intensitymodulated radiation therapy and improved pathologic complete response in locally advanced esophageal cancer[J]. Dis Esophagus, 2017, 30(1):1-9. DOI:10.1093/dote/dox036.
[24] Mariette C, Dahan L, Mornex F, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage Ⅰ and Ⅱ esophageal cancer:final analysis of randomized controlled phase Ⅲ trial FFCD 9901[J]. J Clin Oncol, 2014, 32(23):2416-2422. DOI:10.1200/JCO.2013.53.6532.
[25] Reynolds JV, Ravi N, Hollywood D, et al. Neoadjuvant chemoradiation may increase the risk of respiratory complications and sepsis after transthoracic esophagectomy[J]. J Thorac Cardiovasc Surg, 2006, 132(3):549-555. DOI:10.1016/j.jtcvs.2006.05.015.
[26] FREGAT Working Group. Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection:results of a European multicenter study[J]. Ann Surg, 2014, 260(5):764-771. DOI:10.1097/SLA.0000000000000955.
2020, Vol. 29 
