Effect of SIB-IMRT-based selective dose escalation of local tumor on the prognosis of patients with esophageal cancer

Hong-Mei Gao; Wen-Bin Shen; Jin-Rui Xu; You-Mei Li; Shu-Guang Li; Shu-Chai Zhu

doi:10.1007/s10147-021-01943-7

Effect of SIB-IMRT-based selective dose escalation of local tumor on the prognosis of patients with esophageal cancer

Int J Clin Oncol. 2021 Sep;26(9):1640-1649. doi: 10.1007/s10147-021-01943-7. Epub 2021 May 27.

Authors

Hong-Mei Gao¹, Wen-Bin Shen², Jin-Rui Xu³, You-Mei Li³, Shu-Guang Li³, Shu-Chai Zhu³

Affiliations

¹ Department of Radiation, Shijiazhuang People's Hospital, Shijiazhuang, 050011, China.
² Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhuang, 050011, China. wbshen1979@sina.com.
³ Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhuang, 050011, China.

PMID: 34043101
DOI: 10.1007/s10147-021-01943-7

Abstract

Background: To investigate the effect of SIB-IMRT-based selective dose escalation to local tumor on the prognosis of patients with esophageal cancer (EC).

Methods: A total of 302 EC patients were enrolled. The prognostic factors of the entire group were initially analyzed, and the composition ratios of the two groups and the different doses of each fraction for PTV were compared. The propensity-score matching (PSM) was carried out (1:1 ratio), and the prognostic factors for the two groups were analyzed according to the results of COX.

Results: The median overall survival (OS) for all patients was 30.0 months (23.495-36.505 months), and the median disease-free survival (DFS) was 21.3 months (7.698-24.902 months). In multivariate analysis, chemotherapy, cTNM stage and dose-per-fraction for the PTV were independent prognostic factors for OS (P = 0.013, 0.000, 0.028) and DFS (P = 0.033, 0.000, 0.047). Multivariate analysis of patients after PSM revealed that cTNM staging and dose-per-fraction were the independent prognostic factors for OS (P = 0.000, 0.015). Chemotherapy, cTNM staging and dose-per-fraction for the PTV were the independent prognostic factors for DFS (P = 0.025, 0.010, 0.015). There was no significant difference in grade ≥ 2 acute toxicities between the two groups. A subgroup analysis of patients with a single dose of 2 Gy and > 2 Gy in the SIB-IMRT group showed that OS and DFS of the latter were significantly better than those of the former.

Conclusion: The selective dose escalation to local tumors based on SIB-IMRT technique can improve the survival of patients received radical radiotherapy without increasing toxicities.

Keywords: Esophageal neoplasms/esophageal cancer; Prognosis; Radical radiotherapy; Simultaneous integration boost intensity-modulated radiation therapy; Squamous cell carcinoma.