Prospective phase Ⅱ trial of preventive IMRT combined with concurrent chemotherapy after radical resection of thoracic esophageal squamous cell carcinoma
ZHANG Zhi
ZHOU Guoreng
YE Jinjun
TAO Hua
GU Dayong
LU Jincheng
Abstract：Objective To evaluate the loco-regional control rate and overall survival rate as well as adverse events of prophylactic intensity modulated radiotherapy (IMRT) combined with concurrent chemotherapy after radical resection for thoracic esophageal squamous cell carcinoma.MethodsThis was a prospective phaseⅡtrial.Inclusion criteria were radical thoracic esophageal squamous cell carcinoma with pathological staging of T3-T4or N positive and M0.Radiotherapy technology was IMRT.Radiotherapy range included bilateral supraclavicular region, the mediastinum area, anastomosis and the original tumor bed.The total dose was 50.4Gy in 28 fractions (1.8 Gy/fraction), five fractions weekly.Patients were treated with paclitaxel+cisplatin (TP) regimen (paclitaxel150 mg/m2iv d1, cisplatin 25 mg/m2iv d1-d3, 28 days was a cycle for 2 cycles). The time of local recurrence and distant metastasis after treatment was followed up and recorded.The local control rate and overall survival rate were calculated and the safety of treatment was evaluated.Results From January 2014 to September 2017, the follow-up time was 3-47 months (median 22.8 months). The 1-, 2-overall survival rates and 1-, 2-loco-regional recurrence-free survival rates were 83.9％and 72.9％, 94.9％and 92.5％, respectively.There were 5 cases (6.8％) of regional recurrence, including 4 cases of irradiation field (1 case of supraclavicular bone, 2 cases of mediastinum and 1 case of anastomotic stoma). One case recurred beyond field irradiation as celiac lymph nodes.Among 10 cases (13.5％) of distant metastases, there were lung metastases in 4 cases, liver metastases in 4 cases, and pleural metastases in 2 cases.The main side effects included grade 4 neutropenia in 12 cases (16.2％), platelet decreased in 2 cases (2.7％), as well as grade 3neutropenia in 17 cases (23.0％) and hemoglobin decreased in 1 case (1.4％). After symptomatic treatment, the radiotherapy plan was successfully completed without any suspend or delay in treatment.ConclusionIMRT (range including bilateral supraclavicular region, the mediastinum area, anastomosis and the original tumor bed) combined with concurrent chemotherapy after radical resection for thoracic esophageal squamous cell carcinoma is well tolerated with good local control rate.Patients have a lower probability of recurrence at the lower mediastinum and upper abdomen.It is worth to launch a phaseⅢclinical study.
Keywords：Esophageal squamous cell carcinomaPostoperrationIntensity-modulated radiotherapy (IMRT)PaclitaxelCisplatinTarget region
Publication Date：2018-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 1100-1106 )