Carcinoma of the esophagus: Sites of recurrence and palliative benefits after definitive radiotherapy

doi:10.1016/0360-3016(78)90183-9

International Journal of Radiation OncologyBiologyPhysics

Volume 4, Issues 7–8, July–August 1978, Pages 615-620

https://doi.org/10.1016/0360-3016(78)90183-9 Get rights and content

Abstract

Seventy-two patients were studied who had carcinoma of the esophagus treated by radiation therapy. An analysis of sites of failure in both early and late stage patients revealed that control of local disease in Stage I was good; only 25% of patients developed local failure.

Two other important sites of failure occurred, i.e. marginal recurrence in the esophagus outside the treatment field (25%) and distant metastases (25%). All local recurrences occurred at doses less than 105 time dose-factor (TDF). In patients with Stage II and III disease 64% of evaluable patients had local recurrences. Palliation of symptoms was achieved in a high proportion of patients. Sixty-three per cent of patients had complete disappearance of symptoms, while a further 21% had partial resolution. Complete resolution of symptoms was achieved in over 75% of patients with lesions <5 cm, but only 29% with lesions <9 cm. The probability of complete resolution is significantly greater when doses of greater than 100 TDF are given. Serious complications occurred in only 3 of the 72 patients. Implications for further directions in management are discussed.

References (28)

H.M. Burgess et al.
Carcinoma of the esophagus: A clinicopathological study
Surg. Clin. N. Am.
(1951)
P.J. Fitzpatrick et al.
Half-body radiotherapy
Int. J. Radiat. Oncol. Biol. Phys.
(1976)
American Joint Committee for Cancer Staging and End Results Reporting (AJCCS)
Clinical Staging System for Carcinoma of the Esophagus
J. Berkson et al.
Calculation of survival rates for cancer
J.I. Burn
Cancer of the stomach and esophagus: data concerning management and results
Br. J. Surg.
(1971)
R.J. Dickson
Radiation therapy in carcinoma of the esophagus: a review
Am. J. Med. Sci.
(1961)
J.A.C. Fleming
Carcinoma of the thoracic esophagus: some notes on its pathology and spread in relation to treatment
Br. J. Radiol.
(1943)
G.H. Fletcher et al.
The interplay of radiocurability and tolerance in irradiation of human cancers
J. Radiol. Electrol.
(1975)
J.T. Goodner
Surgical principles of resection and reconstruction
J. Am. Med. Assoc.
(1974)

H.E. Johns et al.

The Physics of Radiology

R. Leborgne et al.

Cancer of the esophagus: results of radiotherapy

Br. J. Radiol.

(1963)

B.T. LeRoux

An analysis of seven hundred cases of carcinoma of the hypopharynx, the esophagus and the proximal stomach

Thorax

(1961)

V.A. Marcial et al.

The role of radiation therapy in esophageal cancer

Radiology

(1966)

Cited by (28)

Expert consensus on radiotherapy combined with immunotherapy for esophageal cancer (2024 edition)
2024, Radiation Medicine and Protection
Radiotherapy represents an essential treatment approach for esophageal cancer. Over recent years, immunotherapy combined with chemotherapy has become the first-line standard treatment for patients with advanced esophageal cancer. Several phase III studies on immunotherapy combined with radiotherapy for locally advanced esophageal cancer are currently underway. Sufficient evidence-based medical data are urgently needed to support the integration of immunotherapy and chemoradiotherapy as a new treatment strategy for patients with locally advanced esophageal cancer. This consensus, formulated based on the latest study results, in-depth research, and thorough discussions, provides a comprehensive set of recommendations. The document extensively covers treatment strategies and evaluation methods for radiotherapy combined with immunotherapy across patients with operable esophageal cancer, inoperable locally advanced esophageal cancer, and advanced esophageal cancer. Moreover, common complications and radiation-related issues associated with radiotherapy combined with immunotherapy are discussed, serving as clinical guidance. Our expert group comprised members from the Professional Committee of Radiation Oncology, China Anti-Cancer Association, the Branch of Radiation Oncology, Chinese Medical Association, and the Branch of Radiation Oncology Treatment Physician, Chinese Medical Doctor Association.
Carcinoma of the Esophagus
2014, Textbook of Gastrointestinal Radiology: Volumes 1-2, Fourth Edition
Three-Dimensional Conformal Radiation Therapy for Esophageal Squamous Cell Carcinoma: Is Elective Nodal Irradiation Necessary?
2010, International Journal of Radiation Oncology Biology Physics
Citation Excerpt :
This supports the use of generous proximal and distal margins for esophageal cancer. However, in two different studies (15, 16), there were few instances of margin failure and failure outside the radiation field when a 5-cm, longitudinal margin was added. In our study, in which we used 3-cm proximal and distal margins, no failure in the esophagus occurred outside the CTV.
To evaluate the local control, survival, and toxicity associated with three-dimensional conformal radiotherapy (3D-CRT) for squamous cell carcinoma (SCC) of the esophagus, to determine the appropriate target volumes, and to determine whether elective nodal irradiation is necessary in these patients.
A prospective study of 3D-CRT was undertaken in patients with esophageal SCC without distant metastases. Patients received 68.4 Gy in 41 fractions over 44 days using late-course accelerated hyperfractionated 3D-CRT. Only the primary tumor and positive lymph nodes were irradiated. Isolated out-of-field regional nodal recurrence was defined as a recurrence in an initially uninvolved regional lymph node.
All 53 patients who made up the study population tolerated the irradiation well. No acute or late Grade 4 or 5 toxicity was observed. The median survival time was 30 months (95% confidence interval, 17.7–41.8). The overall survival rate at 1, 2, and 3 years was 77%, 56%, and 41%, respectively. The local control rate at 1, 2, and 3 years was 83%, 74%, and 62%, respectively. Thirty-nine of the 53 patients (74%) showed treatment failure. Seventeen of the 39 (44%) developed an in-field recurrence, 18 (46%) distant metastasis with or without regional failure, and 3 (8%) an isolated out-of-field nodal recurrence only. One patient died of disease in an unknown location.
In patients treated with 3D-CRT for esophageal SCC, the omission of elective nodal irradiation was not associated with a significant amount of failure in lymph node regions not included in the planning target volume. Local failure and distant metastases remained the predominant problems.
A Phase I/II Study to Evaluate the Toxicity and Efficacy of Accelerated Fractionation Radiotherapy for the Palliation of Dysphagia from Carcinoma of the Oesophagus
2008, Clinical Oncology
Citation Excerpt :
The answer to this question remains elusive in the absence of relevant randomised trials where the primary treatment objective is palliation and dysphagia relief. Once a day conventional fractionation schedules using between 20 Gy in five fractions and 70 Gy in 35 fractions have been reported to provide response rates of 41–93%, with a duration of response between 2.75 and 9 months, and a median duration of survival in the order of 6–14 months [4,10–27]. Direct comparisons between conventional radiotherapy and the accelerated fractionation regimen using a randomised control design [28–32] have focused predominantly on its effect on survival in patients with localised disease, with two studies detecting a survival benefit in favour of the accelerated regimen [28,32].
We hypothesised that accelerated fractionated radiotherapy may provide a good palliative approach for dysphagia relief in patients with incurable oesophageal cancer, significantly reducing the overall duration of treatment, while providing symptom response with an acceptable toxicity profile. A phase I/II accelerated fractionation study was conducted to evaluate the efficacy and toxicity of this approach.
Patients with incurable oesophageal cancer, symptomatic with dysphagia, Eastern Cooperative Oncology Group performance status ≤ 3, without fistula or oesophageal stent in situ, were eligible. Treatment consisted of 40 Gy in 20 fractions, twice a day (2 Gy per fraction, ≥6 h apart), 5 days a week, over 2 weeks.
Of the 39 evaluable patients, the dysphagia response rate was 69% (27/39) with a median response duration of 5.5 months. The median time to response was 4 weeks. Twenty-eight per cent (11/39) of patients had transient worsening in their dysphagia scores. Acute toxicity (weeks 1–8) occurred in 41% (16/39) of patients. An improvement in global quality of life by week 8 was seen in 42% of patients. There were no late neurological sequelae. The median overall survival was 8 (range 1.7–58+) months.
The ideal palliative regimen should be relatively short, with minimal toxicity, while offering a favourable response profile. Accelerated fractionation fulfils these criteria and is a suitable treatment alternative for the palliation of dysphagia, especially if the goal is to deliver a higher total biological dose within a shorter (2 week) period of time.
Carcinoma of the Esophagus
2007, Textbook of Gastrointestinal Radiology
A prospective trial of short-course radiotherapy plus chemotherapy for palliation of dysphagia from advanced esophageal cancer
2000, Radiotherapy and Oncology
Purpose: Between 1994 and 1997, 22 patients with dysphagia from advanced incurable esophageal cancer were enrolled in a phase I/II prospective study to assess the palliative benefit and toxicity of a short course of radiotherapy with chemotherapy.
Methods: The study population included 17 men and five women with a median age of 69 (range 43–84). Patients were treated with 30 Gy in ten fractions to the mediastinum with a concurrent single course of chemotherapy (5-FU, 1000 mg/m², days 1–4 and mitomycin-C 10 mg/m², day 1). Swallowing ability was recorded each day on a self-administered diary card using the five point dysphagia index of the MRC (UK). The median baseline MRC swallowing score was 4 (cannot swallow solids).
Results: Treatment was generally well tolerated, but seven (32%) patients had transient worsening of dysphagia scores immediately following treatment because of esophagitis; fifteen (68%) achieved a complete response (score 1: no difficulty on swallowing) with a median time to normalization of swallowing of 5 weeks. For these patients, the median dysphagia-free interval from time of onset of improvement was 11 weeks (range 1–131 weeks) and 11 (73%) remained dysphagia-free until death.. The remaining patients had no or marginal improvement. Univariate analysis showed no difference between responders and non-responders with respect to age, gender, or histology. Median survival for the entire study population was 20 weeks (range 3–135 weeks).
Conclusions: This prospective trial shows that a short course of radiotherapy plus chemotherapy may produce complete relief of swallowing difficulties in a substantial proportion of patients with acceptable toxicity.

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^§: Professor and Chairman.

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Original contributionCarcinoma of the esophagus: Sites of recurrence and palliative benefits after definitive radiotherapy

Abstract

Surg. Clin. N. Am.

Int. J. Radiat. Oncol. Biol. Phys.

Clinical Staging System for Carcinoma of the Esophagus

Calculation of survival rates for cancer

Cancer of the stomach and esophagus: data concerning management and results

Br. J. Surg.

Radiation therapy in carcinoma of the esophagus: a review

Am. J. Med. Sci.

Carcinoma of the thoracic esophagus: some notes on its pathology and spread in relation to treatment

Br. J. Radiol.

The interplay of radiocurability and tolerance in irradiation of human cancers

J. Radiol. Electrol.

Surgical principles of resection and reconstruction

J. Am. Med. Assoc.

The Physics of Radiology

Cancer of the esophagus: results of radiotherapy

Br. J. Radiol.

An analysis of seven hundred cases of carcinoma of the hypopharynx, the esophagus and the proximal stomach

Thorax

The role of radiation therapy in esophageal cancer

Radiology

Original contribution
Carcinoma of the esophagus: Sites of recurrence and palliative benefits after definitive radiotherapy