Dose escalation of 3D radiotherapy is effective for esophageal squamous cell carcinoma: a multicenter retrospective analysis (3JECROG R-03)

Wencheng Zhang; Jingjing Zhao; Weiming Han; Hualei Zhang; Xin Wang; Chen Li; Junqiang Chen; Xiaomin Wang; Yidian Zhao; Xueying Qiao; Zhiguo Zhou; Chun Han; Shuchai Zhu; Wenbin Shen; Lan Wang; Xiaolin Ge; Xinchen Sun; Kaixian Zhang; Miaomiao Hu; Ling Li; Chongli Hao; Gaofeng Li; Yonggang Xu; Yadi Wang; Na Lu; Miaoling Liu; Shuai Qian; Zefen Xiao; Ping Wang; Qingsong Pang

doi:10.21037/atm-20-4672

Dose escalation of 3D radiotherapy is effective for esophageal squamous cell carcinoma: a multicenter retrospective analysis (3JECROG R-03)

Ann Transl Med. 2020 Sep;8(18):1140. doi: 10.21037/atm-20-4672.

Authors

Wencheng Zhang¹, Jingjing Zhao¹, Weiming Han², Hualei Zhang¹, Xin Wang², Chen Li², Junqiang Chen³, Xiaomin Wang⁴, Yidian Zhao⁴, Xueying Qiao⁵, Zhiguo Zhou⁵, Chun Han⁵, Shuchai Zhu⁵, Wenbin Shen⁵, Lan Wang⁵, Xiaolin Ge⁶, Xinchen Sun⁶, Kaixian Zhang⁷, Miaomiao Hu⁷, Ling Li⁷, Chongli Hao⁷, Gaofeng Li⁸, Yonggang Xu⁸, Yadi Wang⁹, Na Lu⁹, Miaoling Liu¹⁰, Shuai Qian¹⁰, Zefen Xiao², Ping Wang¹, Qingsong Pang¹

Affiliations

¹ Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
² Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Radiation Oncology, Fujian Cancer Hospital/Fujian Medical University Cancer Hospital, Fuzhou, China.
⁴ Department 4th of Radiation Oncology, Anyang Cancer Hospital, Anyang, China.
⁵ Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
⁶ Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁷ Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China.
⁸ Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China.
⁹ Department of Radiation Oncology, The Seventh Medical Center of PLA General Hospital, Beijing, China.
¹⁰ Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding, China.

Abstract

Background: To evaluate the impact of radiation dose escalation on overall survival (OS) in patients with non-metastatic esophageal squamous cell carcinoma (ESCC) treated with radical radiotherapy.

Methods: The clinical data of ESCC patients treated with three-dimensional (3D) radiotherapy alone or chemoradiotherapy were collected from multiple institutes and retrospectively analyzed. Patients who received radiation dose ≥40 Gy were included. Radiation dose as a continuous variable was entered into the Cox regression model by using penalized spline regression to allow for a nonlinear relationship between radiation dose and OS to be identified. Patients were stratified into five groups according to EQD₂. The Kaplan-Meier method was used to assess the OS in different dose groups. Univariate and multivariate analyses were performed to evaluate the factors associated with OS.

Results: A total of 2,469 patients were included from 10 institutes across China. The median follow-up time was 58.3 months [95% confidence interval (CI): 56.4-60.2 months]. The median OS and PFS time were 24.3 months (95% CI: 22.5-26.2 months) and 18.0 months (95% CI: 16.4-19.6 months), respectively. The risk of death decreased sharply with a dose up to 60 to 62 Gy, before increasing slightly after the dose was elevated beyond 62 Gy. Multivariate analysis indicated that the chance of death was significantly decreased in patients who received radiotherapy doses of 60-62 Gy [P=0.028, hazard ratio (HR) 0.85, 95% CI: 0.73-0.98)], compared with those who received radiotherapy doses of 40-60 Gy.

Conclusions: Our results reveal radiation dose is a significant prognostic factor of survival for ESCC patients. Higher radiation dose contributes to much more favorable survival outcomes for ESCC patients receiving radical radiotherapy by modern techniques, and 60 Gy or above might be the most optimal radiation dose.

Keywords: Esophageal squamous cell carcinoma (ESCC); overall survival (OS); radiation dose.