Cancer Res Treat.  2020 Jan;52(1):31-40. 10.4143/crt.2018.624.

Intensity-Modulated Radiotherapy versus Three-Dimensional Conformal Radiotherapy in Definitive Chemoradiotherapy for Cervical Esophageal Squamous Cell Carcinoma: Comparison of Survival Outcomes and Toxicities

• Chen NB
• Qiu B
• Zhang J
• Qiang MY
• Zhu YJ
• Wang B
• Guo JY
• Cai LZ
• Huang SM
• Liu MZ
• Li Q
• Hu YH
• Li QW
• Liu H

• KMID: 2501199
• DOI: http://doi.org/10.4143/crt.2018.624

Abstract

Purpose
The purpose of this study was to compare the survival and toxicities in cervical esophageal squamous cell carcinoma (CESCC) treated by concurrent chemoradiothrapy with either three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT) techniques.
Materials and Methods
A total of 112 consecutive CESCC patients were retrospectively reviewed. 3D-CRT and IMRT groups had been analyzed by propensity score matching method, with sex, age, Karnofsky performance status, induction chemotherapy, and tumor stage well matched. The Kaplan-Meier method and Cox proportional hazards model were used for overall survival (OS) and progression-free survival (PFS). Toxicities were compared between two groups by Fisher exact test.
Results
With a median follow-up time of 34.9 months, the 3-year OS (p=0.927) and PFS (p=0.859) rate was 49.6% and 45.8% in 3D-CRT group, compared with 54.4% and 42.8% in IMRT group. The rates of grade ≥ 3 esophagitis, grade ≥ 2 pneumonitis, esophageal stricture, and hemorrhage were comparable between two groups, while the rate of tracheostomy dependence was much higher in IMRT group than 3D-CRT group (14.3% vs.1.8%, p=0.032). Radiotherapy technique (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.01 to 0.79) and pretreatment hoarseness (HR, 0.12; 95% CI 0.02 to 0.70) were independently prognostic of tracheostomy dependence.
Conclusion
No survival benefits had been observed while comparing IMRT versus 3D-CRT in CESCC patients. IMRT with fraction dose escalation and pretreatment hoarseness were considered to be associated with a higher risk for tracheostomy dependence. Radiation dose escalation beyond 60 Gy should be taken into account carefully when using IMRT with hypofractionated regimen.

Keyword

Cervical esophageal squamous cell carcinoma; Conformal radiotherapy; Intensity-modulated radiotherapy; Survival; Tracheostomy dependence

Figure

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  Fig. 1. Overall survival (OS) (A) and progression-free survival (PFS) (B) between the three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) groups. There was no statistically significant difference observed in OS (p=0.927, log-rank) and PFS (p=0.859, log-rank) between the 3D-CRT group and the IMRT group.

Reference

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