A Prospectively Randomized Study Of Clinical Target Volume Margins For 3-Dimensional Conformal Radiation Therapy In Patients With Squamous Cell Carcinoma Of Thoracic Esophagus

Purpose/Objective(s)To observe prospectively the effect of different clinical target volumes (CTVs) on prognosis in patients with thoracic esophageal squamous cell carcinoma (SCC) and find out the optional CTV margins for three-dimensional conformal radiation therapy (3DCRT) in patients with thoracic esophagus (SCC).Materials/MethodsNinety-four patients with thoracic esophageal SCC between May 2006 and November 2009 were randomized into two groups: the elective nodal irradiation group (the elective group) and the involved nodal irradiation group (the involved group). All the patients received 3DCRT. For the 49 patients of involved group, the CTV was defined as the GTV plus a 3-cm margin superior and inferior to the primary tumor and a 0.8-1.0 cm radial margin. In the elective group, besides the same margins outside the primary tumor as that in the involved nodal irradiation group, the adjacent regional lymphatics was included in the CTV according to the different location of the primary tumor.ResultsFor the entire group, the 1-, and 3-year survival rates were 67.7%, and 35.7% respectively. The median survival was 24.6 months. The 1-, and 3-year survival rates were 66.9%, 36.2% in the involved group and 68.6%, 35.5% in the elective group respectively (p = 0.961). The 1-, and 3-year locoregional control rates were 72.4%, 54.5% and 69.5%, 46.0% in the involved group and in the elective group respectively (p = 0.640). The 1-, and 3-year progression-free survival rates were 63.8%, 43.7% and 64.8%, 40.6% in the two groups respectively (p = 0.887). Grade II and higher radiation esophagitis was 32.7% and 42.2%, respectively (p = 0.338). The symptomatic radiation pneumonitis was 30.6% and 35.6%, respectively in the two groups (p = 0.464).ConclusionsConformal radiation therapy with elective nodal irradiation for thoracic esophageal SCC showed no significant advantage over the conformal radiation therapy with the involved nodal irradiation in overall survival, locoregional control, and progression-free survival. Conformal radiation therapy with elective nodal irradiation conferred a higher radiation esophagitis, pneumonitis. Purpose/Objective(s)To observe prospectively the effect of different clinical target volumes (CTVs) on prognosis in patients with thoracic esophageal squamous cell carcinoma (SCC) and find out the optional CTV margins for three-dimensional conformal radiation therapy (3DCRT) in patients with thoracic esophagus (SCC). To observe prospectively the effect of different clinical target volumes (CTVs) on prognosis in patients with thoracic esophageal squamous cell carcinoma (SCC) and find out the optional CTV margins for three-dimensional conformal radiation therapy (3DCRT) in patients with thoracic esophagus (SCC). Materials/MethodsNinety-four patients with thoracic esophageal SCC between May 2006 and November 2009 were randomized into two groups: the elective nodal irradiation group (the elective group) and the involved nodal irradiation group (the involved group). All the patients received 3DCRT. For the 49 patients of involved group, the CTV was defined as the GTV plus a 3-cm margin superior and inferior to the primary tumor and a 0.8-1.0 cm radial margin. In the elective group, besides the same margins outside the primary tumor as that in the involved nodal irradiation group, the adjacent regional lymphatics was included in the CTV according to the different location of the primary tumor. Ninety-four patients with thoracic esophageal SCC between May 2006 and November 2009 were randomized into two groups: the elective nodal irradiation group (the elective group) and the involved nodal irradiation group (the involved group). All the patients received 3DCRT. For the 49 patients of involved group, the CTV was defined as the GTV plus a 3-cm margin superior and inferior to the primary tumor and a 0.8-1.0 cm radial margin. In the elective group, besides the same margins outside the primary tumor as that in the involved nodal irradiation group, the adjacent regional lymphatics was included in the CTV according to the different location of the primary tumor. ResultsFor the entire group, the 1-, and 3-year survival rates were 67.7%, and 35.7% respectively. The median survival was 24.6 months. The 1-, and 3-year survival rates were 66.9%, 36.2% in the involved group and 68.6%, 35.5% in the elective group respectively (p = 0.961). The 1-, and 3-year locoregional control rates were 72.4%, 54.5% and 69.5%, 46.0% in the involved group and in the elective group respectively (p = 0.640). The 1-, and 3-year progression-free survival rates were 63.8%, 43.7% and 64.8%, 40.6% in the two groups respectively (p = 0.887). Grade II and higher radiation esophagitis was 32.7% and 42.2%, respectively (p = 0.338). The symptomatic radiation pneumonitis was 30.6% and 35.6%, respectively in the two groups (p = 0.464). For the entire group, the 1-, and 3-year survival rates were 67.7%, and 35.7% respectively. The median survival was 24.6 months. The 1-, and 3-year survival rates were 66.9%, 36.2% in the involved group and 68.6%, 35.5% in the elective group respectively (p = 0.961). The 1-, and 3-year locoregional control rates were 72.4%, 54.5% and 69.5%, 46.0% in the involved group and in the elective group respectively (p = 0.640). The 1-, and 3-year progression-free survival rates were 63.8%, 43.7% and 64.8%, 40.6% in the two groups respectively (p = 0.887). Grade II and higher radiation esophagitis was 32.7% and 42.2%, respectively (p = 0.338). The symptomatic radiation pneumonitis was 30.6% and 35.6%, respectively in the two groups (p = 0.464). ConclusionsConformal radiation therapy with elective nodal irradiation for thoracic esophageal SCC showed no significant advantage over the conformal radiation therapy with the involved nodal irradiation in overall survival, locoregional control, and progression-free survival. Conformal radiation therapy with elective nodal irradiation conferred a higher radiation esophagitis, pneumonitis. Conformal radiation therapy with elective nodal irradiation for thoracic esophageal SCC showed no significant advantage over the conformal radiation therapy with the involved nodal irradiation in overall survival, locoregional control, and progression-free survival. Conformal radiation therapy with elective nodal irradiation conferred a higher radiation esophagitis, pneumonitis.