Background
Materials and methods
Eligibility criteria
Pretreatment evaluation
Radiation therapy and chemotherapy
Location | Upper margin | Lower margin | Lymph node stations included in CTV |
---|---|---|---|
Upper thoracic esophagus (Ut) | Cricothyroid membrane / 1–1 .5cm superior to the highest metastatic lymph node | 3 cm inferior to the lower margin of the tumor / 1–1 .5cm inferior to the lowest metastatic lymph node | supraclavicular, station 1R, 1 L, 2R, 2 L, 4R, 4 L, 7 (station 3, 8, paracardial and left gastric lymph nodes may be included if metastatic lymph nodes exist) |
Middle thoracic esophagus (Mt) | First thoracic vertebra / 1–1 .5cm superior to the highest metastatic lymph node | 3 cm inferior to the lower margin of the tumor / 1–1 .5cm inferior to the lowest metastatic lymph node | supraclavicular, station 1R, 1 L, 2R, 2 L, 4R, 4 L, 7, 8 (station 3, paracardial and left gastric lymph nodes may be included if metastatic lymph nodes exist) |
Lower thoracic esophagus (Lt) | 3-5 cm superior to the tumor / 1–1 .5cm superior to the highest metastatic lymph node | 3 cm inferior to the lower margin of the tumor / 1–1 .5cm inferior to the lowest metastatic lymph node | station 2R, 2 L, 4R, 4 L, 7, 8, paracardial and left gastric lymph nodes (supraclavicular, staion1R, 1 L, 3 may be included if metastatic lymph nodes exist) |
Toxicity evaluation
Radiation dose escalation
Statistical analysis
Follow-up and evaluation
Results
Patient Characteristics & Dose–volume parameters
Characteristic | No. of patients | % |
---|---|---|
Total patients | 53 | 100 |
Age, years | ||
Median | 58 | |
Range | 41–69 | |
Gender | ||
Female | 6 | 11 |
Male | 47 | 89 |
Karnofsky Performance Status | ||
100 | 1 | 2 |
90 | 29 | 55 |
80 | 22 | 41 |
70 | 1 | 2 |
Tumor Length, cm | ||
Median | 6 | |
Range | 2–14 | |
Length<3 cm | 2 | 4 |
3 cm ≤ Length<5 cm | 12 | 23 |
5 cm ≤ Length<10 cm | 35 | 66 |
Length ≥ 10 cm | 4 | 7 |
Clinical Stage (UICC 2002) | ||
T stage | ||
T1 | 3 | 6 |
T2 | 7 | 13 |
T3 | 21 | 40 |
T4 | 22 | 41 |
N stage | ||
N0 | 1 | 2 |
N1 | 52 | 98 |
TNM stage | ||
IIA | 1 | 2 |
IIB | 6 | 11 |
III | 23 | 43 |
IVA | 10 | 19 |
IVB | 13 | 25 |
Radiotherapy Technique | ||
SIB-IMRT | 35 | 66 |
SIB-VMAT | 18 | 34 |
GTV volume (cm3) | ||
Median | 41.77 | |
Range | 6.30–144.04 | |
GTV-nd volume (cm3) | 10.53 | |
0.00–46.67 | ||
PGTV volume (cm3) | ||
Median | 175.54 | |
Range | 36.59–374.09 | |
CTV volume (cm3) | ||
Median | 364.72 | |
Range | 172.47–562.21 | |
PTV volume (cm3) | ||
Median | 630.91 | |
Range | 325.14–854.99 |
Maximum Tolerated Dose & Treatment compliance
Treatment-related toxicity
Toxicity | Grade 1 | Grade 2 | Grade 3 | Grade 4 | Grade 5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
n
| % |
n
| % |
n
| % |
n
| % |
n
| % | |
Acute | ||||||||||
Leukopenia | 18 | (34) | 17 | (32) | 11 | (21) | 0 | (0) | 0 | (0) |
Anemia | 11 | (21) | 0 | (0) | 1 | (2) | 0 | (0) | 0 | (0) |
Thrombocytopenia | 6 | (11) | 6 | (11) | 1 | (2) | 1 | (2) | 0 | (0) |
Skin Reaction | 33 | (62) | 12 | (23) | 0 | (0) | 0 | (0) | 0 | (0) |
Esophagitis | 26 | (49) | 19 | (36) | 7 | (13) | 1 | (2) | 0 | (0) |
Weight Loss | 15 | (28) | 0 | (0) | 0 | (0) | 0 | (0) | 0 | (0) |
Upper G.I. | 15 | (28) | 2 | (4) | 5 | (9) | 0 | (0) | 0 | (0) |
Pneumonitis | 1 | (2) | 0 | (0) | 3 | (6) | 0 | (0) | 0 | (0) |
Tracheitis | 17 | (32) | 2 | (4) | 0 | (0) | 0 | (0) | 0 | (0) |
Late | ||||||||||
Esophageal perforation | 0 | (0) | 3 | (6) | 0 | (0) | 0 | (0) | 0 | (0) |
Esophageal hemorrhage | 0 | (0) | 0 | (0) | 0 | (0) | 0 | (0) | 1 | (2) |