Survival Outcomes of Cervical Esophageal Cancer Treated with Definitive Chemoradiotherapy using Intensity modulated or 3D Conformal Radiation Therapy: A Single Institute Experience

Abstract

Abstract Objective: The aim of this study is to report the survival and treatment results of patients with cervical esophageal cancer treated with definitive chemoradiotherapy, whose incidence is very low in the population and there is not enough information about treatment and toxicity results in the literature. Material and Method: Between 2013 and 2022, 10 patients (six males and four females) with cervical esophageal cancer treated with definitive chemoradiotherapy were included. Among these patients, seven had stage II disease, one stage III, and 2 stage IVA. All patients received radiotherapy at a median dose of 50.4 Gy and concurrent weekly chemotherapy. Results: The median follow-up period was 18 months. The two-year and 5-year overall survival rates were 42.2% and 21.1%, respectively. The two-year and 5-year disease-free survival rates were 45.7% and 22.9%, respectively. Disease progression was noted in 3 out of 10 patients (30%). Three patients were still alive during analyze. Percutaneous enteral gastrostomy was performed in 3 of 10 patients. These requirement occured in 1 due to local progression, and in the remaining 2 patients due to the side effect of RT. Conclusions: Overall survival rates were low, as similar findings appear in the literature. It was remarkable that the need for a percutaneous enteral gastrostomy was not observed in the IMRT group. All patients with complete remission were in stage 2.

Keywords

• Cervical esophageal cancer
• squamous cell carcinoma
• definitive chemoradiotherapy
• survival
• toxicity

Yoğunluk Ayarlı veya 3 Boyutlu Konformal Radyasyon Tedavisi Kullanılarak Definitif Kemoradyoterapi İle Tedavi Edilen Servikal Özofagus Kanserinin Sağkalım Sonuçları: Tek Merkez Deneyimi

Abstract

Öz Amaç: Bu çalışmanın amacı, popülasyonda insidansı çok düşük olan ve literatürde tedavi ve toksisite sonuçları hakkında yeterli bilgi bulunmayan, definitif kemoradyoterapi ile tedavi edilen servikal özofagus kanserli hastaların sağkalım ve tedavi sonuçlarını bildirmektir. Gereç ve Yöntem: 2013-2022 yılları arasında definitif kemoradyoterapi ile tedavi edilen servikal özofagus kanserli 10 hasta (altı erkek ve dört kadın) dahil edildi. Bu hastaların yedisinde evre II hastalık, birinde evre III ve ikisinde evre IVA hastalık vardı. Tüm hastalar medyan 50.4 Gy dozda radyoterapi ve eş zamanlı haftalık kemoterapi aldı. Bulgular: Ortanca takip süresi 18 aydı. İki yıllık ve 5 yıllık genel sağkalım oranları sırasıyla %42.2 ve %21.1 idi. İki yıllık ve 5 yıllık hastalıksız sağkalım oranları sırasıyla %45.7 ve %22.9 idi. 10 hastanın 3'ünde (%30) hastalık progresyonu kaydedildi. Analiz sırasında üç hasta hala hayattaydı. 10 hastanın 3'üne perkütan enteral gastrostomi uygulandı. Bu gereksinim 1 hastada lokal progresyon nedeniyle, geri kalan 2 hastada RT'nin yan etkisi nedeniyle ortaya çıktı. Sonuçlar: Literatürdekine benzer şekilde genel sağkalım oranları düşüktü. IMRT grubunda perkütan enteral gastrostomi ihtiyacının görülmemesi dikkat çekiciydi. Tam remisyona tespit edilen tüm hastalar evre 2'deydi. Çok merkezli randomize çalışmalara ihtiyaç vardır.

Keywords

• Cervical esophageal cancer
• squamous cell carcinoma
• definitive chemoradiotherapy
• survival
• toxicity

References

1. 1. Tachimori Y, Ozawa S, Numasaki H, Ishihara R, Matsubara H, Muro K, Oyama T, Toh Y, Udagawa H, Uno T; Registration Committee for Esophageal Cancer of the Japan Esophageal Society. Comprehensive registry of esophageal cancer in Japan, 2012. Esophagus. 2019;16(3):221-245.
2. 2. Cao CN, Luo JW, Gao L, Xu GZ, Yi JL, Huang XD, Li SY, Xiao JP, Liu SY, Xu ZG, Tang PZ. Primary radiotherapy compared with primary surgery in cervical esophageal cancer. JAMA Otolaryngol Head Neck Surg. 2014;140(10):918-26.
3. 3. Valmasoni M, Pierobon ES, Zanchettin G, Briscolini D, Moletta L, Ruol A, Salvador R, Merigliano S. Cervical Esophageal Cancer Treatment Strategies: A Cohort Study Appraising the Debated Role of Surgery. Ann Surg Oncol. 2018;25(9):2747-2755.
4. 4. Cao C, Luo J, Gao L, Xu G, Yi J, Huang X, Wang K, Zhang S, Qu Y, Li S, Xiao J, Zhang Z. Definitive intensity-modulated radiotherapy compared with definitive conventional radiotherapy in cervical oesophageal squamous cell carcinoma. Radiol Med. 2015 ;120(7):603-10.
5. 5. Burmeister BH, Dickie G, Smithers BM, Hodge R, Morton K. Thirty-four patients with carcinoma of the cervical esophagus treated with chemoradiation therapy. Arch Otolaryngol Head Neck Surg. 2000;126(2):205-8.
6. 6. Yamada K, Murakami M, Okamoto Y, Okuno Y, Nakajima T, Kusumi F, Takakuwa H, Matsusue S. Treatment results of radiotherapy for carcinoma of the cervical esophagus. Acta Oncol. 2006;45(8):1120-5.
7. 7. Uno T, Isobe K, Kawakami H, Ueno N, Shimada H, Matsubara H, Okazumi S, Nabeya Y, Shiratori T, Kawata T, Ochiai T, Ito H. Concurrent chemoradiation for patients with squamous cell carcinoma of the cervical esophagus. Dis Esophagus. 2007;20(1):12-8.
8. 8. De Virgilio A, Costantino A, Festa BM, Mercante G, Franceschini D, Franzese C, Scorsetti M, Marrari A, Cavina R, Marano S, Castoro C, Spriano G. Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis. J Cancer Res Clin Oncol . 2023;149(3):1029-1041

9. 9. Nakata Y, Hanai N, Nishikawa D, Suzuki H, Koide Y, Fukuda Y, Nomura M, Kodaira T, Shimizu T, Hasegawa Y. Comparison between chemoselection and definitive radiotherapy in patients with cervical esophageal squamous cell carcinoma. Int J Clin Oncol. 2017;22(6):1034-1041.
10. 10. Kim TH, Lee IJ, Kim JH, Lee CG, Lee YC, Kim JW. High-dose versus standard-dose radiation therapy for cervical esophageal cancer: Retrospective single-institution study. Head Neck. 2019;41(1):146-153.
11. 11. Ito M, Kodaira T, Tachibana H, Tomita N, Makita C, Koide Y, Kato D, Abe T, Muro K, Tajika M, Niwa Y, Hasegawa Y. Clinical results of definitive chemoradiotherapy for cervical esophageal cancer: Comparison of failure pattern and toxicities between intensity-modulated radiotherapy and 3-dimensional conformal radiotherapy. Head Neck. 2017;39(12):2406-2415.
12. 12. Daiko H, Hayashi R, Saikawa M, Sakuraba M, Yamazaki M, Miyazaki M, Ugumori T, Asai M, Oyama W, Ebihara S. Surgical management of carcinoma of the cervical esophagus. J Surg Oncol. 2007;96(2):166-72
13. 13. Wang HW, Chu PY, Kuo KT, Yang CH, Chang SY, Hsu WH, Wang LS. A reappraisal of surgical management for squamous cell carcinoma in the pharyngoesophageal junction. J Surg Oncol. 2006;93(6):468-76.
14. 14. Zhao D, Zheng B, Xiao S, Liu W, Xu X, Yu H, Sun Y, Wang W. Mapping of Regional Failures After Definitive Radiotherapy in Patients with Locally Advanced Cervical Esophageal Carcinoma. Cancer Manag Res. 2020;12:5293-5299.
15. 15. Hulshof MCCM, Geijsen ED, Rozema T, Oppedijk V, Buijsen J, Neelis KJ, Nuyttens JJME, van der Sangen MJC, Jeene PM, Reinders JG, van Berge Henegouwen MI, Thano A, van Hooft JE, van Laarhoven HWM, van der Gaast A. Randomized Study on Dose Escalation in Definitive Chemoradiation for Patients With Locally Advanced Esophageal Cancer (ARTDECO Study). J Clin Oncol. 2021;39(25):2816-2824.