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Effect of SIB-IMRT-based selective dose escalation of local tumor on the prognosis of patients with esophageal cancer

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Abstract

Background

To investigate the effect of SIB-IMRT-based selective dose escalation to local tumor on the prognosis of patients with esophageal cancer (EC).

Methods

A total of 302 EC patients were enrolled. The prognostic factors of the entire group were initially analyzed, and the composition ratios of the two groups and the different doses of each fraction for PTV were compared. The propensity-score matching (PSM) was carried out (1:1 ratio), and the prognostic factors for the two groups were analyzed according to the results of COX.

Results

The median overall survival (OS) for all patients was 30.0 months (23.495–36.505 months), and the median disease-free survival (DFS) was 21.3 months (7.698–24.902 months). In multivariate analysis, chemotherapy, cTNM stage and dose-per-fraction for the PTV were independent prognostic factors for OS (P = 0.013, 0.000, 0.028) and DFS (P = 0.033, 0.000, 0.047). Multivariate analysis of patients after PSM revealed that cTNM staging and dose-per-fraction were the independent prognostic factors for OS (P = 0.000, 0.015). Chemotherapy, cTNM staging and dose-per-fraction for the PTV were the independent prognostic factors for DFS (P = 0.025, 0.010, 0.015). There was no significant difference in grade ≥ 2 acute toxicities between the two groups. A subgroup analysis of patients with a single dose of 2 Gy and > 2 Gy in the SIB-IMRT group showed that OS and DFS of the latter were significantly better than those of the former.

Conclusion

The selective dose escalation to local tumors based on SIB-IMRT technique can improve the survival of patients received radical radiotherapy without increasing toxicities.

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Abbreviations

EC:

Esophageal cancer

SIB-IMRT:

Simultaneous integrated boost intensity-modulation radiation therapy

PSM:

Propensity-score matching

OS:

Overall survival

CI:

Confidence interval

DFS:

Disease-free survival

ESCC:

Esophageal squamous cell carcinoma

EA:

Esophageal adenocarcinoma

CRT:

Concurrent chemoradiotherapy

LCR:

Locoregional control rate

IMRT:

Intensity-modulated radiation therapy

LCB-IMRT:

Late course boost intensity-modulated radiation therapy

ECOG:

Eastern cooperative oncology group

CT:

Computed tomography

EUS:

Endoscopic ultrasonography

18FDG-PET/CT:

(18) Fluoro-2-deoxy-d-glucose (18FDG) positron emission tomography-computed tomography (PET-CT)

UICC:

Union for international cancer control

GTV:

Gross tumor volume

CTV:

Clinical target volume

PTV:

Planning target volumes

OARs:

Organs at risk

MLD:

Mean lung dose

MHD:

Mean heart dose

CTCAE:

National common terminology criteria for adverse events

3DCRT:

Three-dimensional conformal radiation therapy

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Authors and Affiliations

  1. Department of Radiation, Shijiazhuang People’s Hospital, Shijiazhuang, 050011, China

    Hong-Mei Gao

  2. Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang’an District, Shijiazhuang, 050011, China

    Wen-Bin Shen, Jin-Rui Xu, You-Mei Li, Shu-Guang Li & Shu-Chai Zhu

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Correspondence to Wen-Bin Shen.

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Gao, HM., Shen, WB., Xu, JR. et al. Effect of SIB-IMRT-based selective dose escalation of local tumor on the prognosis of patients with esophageal cancer. Int J Clin Oncol 26, 1640–1649 (2021). https://doi.org/10.1007/s10147-021-01943-7

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  • DOI: https://doi.org/10.1007/s10147-021-01943-7

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