Three-Dimensional Conformal Radiotherapy-Based or Intensity-Modulated Radiotherapy-Based Concurrent Chemoradiotherapy in Patients with Thoracic Esophageal Squamous Cell Carcinoma

• Main Authors: Wei-Cheng Lin, Chia-Lun Chang, Han-Lin Hsu, Kevin Sheng-Po Yuan, Alexander T. H. Wu, Szu-Yuan Wu
• Format: Article
• Language: English
• Published: MDPI AG 2019-10-01
• Series: Cancers
• Subjects: thoracic esophageal cancer; squamous cell carcinoma; intensity-modulated radiation therapy; concurrent chemoradiotherapy; three-dimensional conformal radiation therapy
• Online Access: https://www.mdpi.com/2072-6694/11/10/1529

Background: To date, intensity-modulated radiation therapy (IMRT) with concurrent chemoradiotherapy (CCRT) and CCRT with standard fractionation three-dimensional conformal radiation therapy (3D-CRT) have not been compared. In this study, the outcomes of IMRT-based concurrent CCRT and those of 3D-CRT-based CCRT were compared in patients with thoracic esophageal squamous cell carcinoma (TESCC). Methods: We enrolled 2062 patients with TESCC who had received CCRT and categorized them into two groups on the basis of their treatment modality: Group 1 (3D-CRT-based CCRT) and Group 2 (IMRT-based CCRT). Results: Multivariate Cox regression analysis indicated that the American Joint Committee on Cancer advanced stages (&#8805;IIIA) and 3D-CRT were significant independent predictors of poor outcomes in patients with TESCC who received definitive CCRT. Moreover, receiving IMRT-based CCRT (adjusted hazard ratio [aHR]: 0.88, 95% confidence interval [CI]: 0.78&#8722;0.98) was a significant independent prognostic factor for overall survival (<i>p</i> = 0.0223). In Group 2, aHRs (95% CIs) for overall mortality at early (IA&#8722;IIB) and advanced clinical stages were 0.91 (0.67&#8722;1.25, <i>p</i> = 0.5746) and 0.88 (0.77&#8722;0.99, <i>p</i> = 0.0368), respectively. Conclusion: IMRT-based CCRT resulted in higher survival rates in patients with advanced clinical stages of TESCC (i.e., IIIA&#8722;IIIC), namely, clinical T3, clinical T4, or lymph node involvement.