Radiation Dose-escalated Chemoradiotherapy Using Simultaneous Integrated Boost Intensity-Modulated Radiotherapy for Locally Advanced Unresectable Thoracic Oesophageal Squamous Cell Carcinoma: A Single-institution Phase I Study.
Chemoradiotherapy
intensity-modulated radiotherapy
oesophageal cancer
phase I clinical trial
radiation dose hypofractionation
Journal
Clinical oncology (Royal College of Radiologists (Great Britain))
ISSN: 1433-2981
Titre abrégé: Clin Oncol (R Coll Radiol)
Pays: England
ID NLM: 9002902
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
17
03
2020
revised:
22
05
2020
accepted:
15
07
2020
pubmed:
10
8
2020
medline:
15
10
2021
entrez:
10
8
2020
Statut:
ppublish
Résumé
About 80% of cases of locally advanced unresectable thoracic oesophageal squamous cell carcinoma recur within the irradiation fields after chemoradiotherapy. Radiation dose escalation using advanced radiotherapy techniques is expected to improve clinical outcomes by reducing local and regional recurrence. The current study aimed to determine the recommended escalated radiation dose for these patients. Patients with locally advanced unresectable thoracic oesophageal squamous cell carcinoma with good performance status underwent chemoradiotherapy using simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) with elective nodal irradiation. SIB-IMRT was delivered in five fractions per week. The radiation dose to the unresectable gross tumour was escalated from 66 Gy to a planned maximum dose of 72 Gy in 3 Gy increments in a standard 3 + 3 design. The doses to the resectable component, superficial tumours and elective nodal regions were fixed as 60, 51 and 48 Gy, respectively. Cisplatin and 5-fluorouracil were concurrently administered. Dose-limiting toxicity (DLT) was defined as acute grade 3 oesophagitis, grade 2 pneumonitis, grade 2 cardiac toxicity and a failure to complete planned radiotherapy within 60 days. Locoregional control and overall survival were estimated using the Kaplan-Meier method. Nine patients were enrolled. DLTs occurred in one of six and two of three patients at doses of 66 and 69 Gy, respectively. All DLTs were grade 3 oesophagitis. The recommended dose was determined as 66 Gy delivered in 30 fractions based on the predefined criteria. With a median follow-up period of 23 months, the 1-year locoregional control and overall survival rates were 67 (95% confidence interval = 19-90) and 78% (95% confidence interval = 36-94), respectively. The recommended radiation dose in chemoradiotherapy using SIB-IMRT with elective nodal irradiation was 66 Gy delivered in 30 fractions.
Identifiants
pubmed: 32768158
pii: S0936-6555(20)30294-6
doi: 10.1016/j.clon.2020.07.012
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT02741856', 'NCT04086901']
Types de publication
Clinical Trial, Phase I
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
191-201Informations de copyright
Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.