| Citation: |
KONG Yan, DONG Qian, LI Shuguang, XU Jinrui, ZHAO Xiaohan, DENG Wenzhao, SHEN Wenbin. Influence of Local Tumor Factors and Radiotherapy Dose on Prognosis of Clinical Stage T1-4N0M0 Esophageal Squamous Cell Carcinoma[J]. Cancer Research on Prevention and Treatment, 2025, 52(3): 225-232. DOI: 10.3971/j.issn.1000-8578.2025.24.0721
|
To investigate the effect of different radiotherapy doses on the prognosis of patients with stage cT1-4N0M0 esophageal squamous cell carcinoma (ESCC) who received radical radio (chemo)therapy categorized into subgroups with different tumor local factors.
A retrospective analysis was conducted on 256 patients with clinically nonmetastatic esophageal squamous cell carcinoma. The optimal cutoff for tumor local factors was determined. The relationship between latest treatment efficacy and tumor local factors was analyzed, and independent indicators affecting patient overall survival (OS) were examined using multivariate analysis. The subgroup analysis was performed to determine the correlation between selected factors and radiation therapy doses.
The shorter the X-ray length of esophageal tumor lesion and the smaller the lesion canal wall thickness and gross tumor volume (GTV), the better the latest treatment efficacy of the patients (χ2=9.066, 10.310, 15.661, respectively, P=0.011, 0.006, P<0.001). Multivariate analysis results showed that GTV(P<0.001), radiation dose(P=0.038), and latest treatment efficacy(P<0.001) were independent predictors of the patients’ OS, and the latter two were also independent predictors of the patients’ progression-free survival (PFS) (P=0.033, <0.001). Subgroup analysis further showed that high doses of radiotherapy (over 60 Gy) resulted in good OS (χ2=5.040, 4.588, 5.400, P=0.025, 0.032, 0.020) and PFS (χ2=6.089, 4.353, 6.459, P=0.014, 0.037, 0.011) in the subgroup with maximum wall thickness below 3.7 cm, with esophageal lesions with GTV below 37.34 cm3, or not receiving simultaneous chemotherapy.
Local tumor factors are important prognostic factors of ESCC patients treated with radical radio(chemo)therapy. Patients with thin lesion walls and small tumor volumes may greatly benefit from high doses of radiation (over 60 Gy).
Competing interests: The authors declare that they have no competing interests.
| [1] |
Park S, Oh D, Choi YL, et al. Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma[J]. Cancer, 2022, 128(11): 2148-2158. doi: 10.1002/cncr.34176
|
| [2] |
Wei T, Ti W, Song Q, et al. Study of PD-1 Inhibitors in Combination with Chemoradiotherapy/Chemotherapy in Patients with Esophageal Squamous Carcinoma[J]. Curr Oncol, 2022, 29(5): 2920-2927. doi: 10.3390/curroncol29050238
|
| [3] |
Zhu H, Rivin Del Campo E, Ye J, et al. Involved-Field Irradiation in Definitive Chemoradiotherapy for Locoregional Esophageal Squamous Cell Carcinoma: Results From the ESO-Shanghai 1 Trial[J]. Int J Radiat Oncol Biol Phys, 2021, 110(5): 1396-1406. doi: 10.1016/j.ijrobp.2021.02.053
|
| [4] |
Li M, Zhang X, Zhao F, et al. Involved-field radiotherapy for esophageal squamous cell carcinoma: theory and practice[J]. Radiat Oncol, 2016, 11: 18. doi: 10.1186/s13014-016-0589-7
|
| [5] |
Chow R, Lock M, Lee SL, et al. Esophageal Cancer Radiotherapy Dose Escalation Meta Regression Commentary: "High vs. Low Radiation Dose of Concurrent Chemoradiotherapy for Esophageal Carcinoma With Modern Radiotherapy Techniques: A Meta-Analysis"[J]. Front Oncol, 2021, 11: 700300. doi: 10.3389/fonc.2021.700300
|
| [6] |
Zhang W, Xie Q, Zhu B, et al. Intensity-modulated radiotherapy with more than 60 Gy improved the survival of inoperable patients with locally advanced esophageal squamous cell carcinoma: A population-based real-world study[J]. Medicine (Baltimore), 2022, 101(16): e29166. doi: 10.1097/MD.0000000000029166
|
| [7] |
Huang BT, Huang RH, Zhang WZ, et al. Different definitions of esophagus influence esophageal toxicity prediction for esophageal cancer patients administered simultaneous integrated boost versus standard-dose radiation therapy[J]. Sci Rep, 2017, 7(1): 120. doi: 10.1038/s41598-017-00168-x
|
| [8] |
Chen NB, Qiu B, Zhang J, et al. Intensity-Modulated Radiotherapy versus Three-Dimensional Conformal Radiotherapy in Definitive Chemoradiotherapy for Cervical Esophageal Squamous Cell Carcinoma: Comparison of Survival Outcomes and Toxicities[J]. Cancer Res Treat, 2020, 52(1): 31-40. doi: 10.4143/crt.2018.624
|
| [9] |
Zhang J, Zhang W, Zhang B, et al. Clinical results of intensity-modulated radiotherapy for 250 patients with cervical and upper thoracic esophageal carcinoma[J]. Cancer Manag Res, 2019, 11: 8285-8294. doi: 10.2147/CMAR.S203575
|
| [10] |
Hermann RM, Kober L, Christiansen H. Stereotactic body radiation therapy: radiobiological characteristics, physical-technical prerequisites, clinical applications[J]. Radiologe, 2021, 61(9): 853-862. doi: 10.1007/s00117-021-00903-6
|
| [11] |
Shioyama Y, Onishi H, Takayama K, et al. Clinical Outcomes of Stereotactic Body Radiotherapy for Patients With Stage I Small-Cell Lung Cancer: Analysis of a Subset of the Japanese Radiological Society Multi-Institutional SBRT Study Group Database[J]. Technol Cancer Res Treat, 2018, 17: 1533033818783904.
|
| [12] |
Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1[J]. Esophagus, 2019, 16(1): 1-24. doi: 10.1007/s10388-018-0641-9
|
| [13] |
Shen WB, Zhu SC, Gao HM, et al. Analysis of failure patterns in patients with resectable esophageal squamous cell carcinoma receiving chemoradiotherapy[J]. J Cancer Res Ther, 2016, 12(1): 62-68. doi: 10.4103/0973-1482.146128
|
| [14] |
Qin Q, Ge X, Wang X, et al. Stage Ⅲ Esophageal Squamous Cell Carcinoma Patients With Three-Dimensional Conformal or Intensity-Modulated Radiotherapy: A Multicenter Retrospective Study[J]. Front Oncol, 2020, 10: 580450. doi: 10.3389/fonc.2020.580450
|
| [15] |
Jiang N, Ge XL, Zhang ZY, et al. Prognostic Factors for Patients with Esophageal Cancer Receiving Definitive Radiotherapy Alone: A Retrospective Analysis[J]. Cancer Manag Res, 2021, 13: 3229-3234. doi: 10.2147/CMAR.S300672
|
| [16] |
Bütof R, Löck S, Soliman M, et al. Dose-volume predictors of early esophageal toxicity in non-small cell lung cancer patients treated with accelerated-hyperfractionated radiotherapy[J]. Radiother Oncol, 2020, 143: 44-50. doi: 10.1016/j.radonc.2019.11.002
|
| [17] |
Zhao J, Lei T, Zhang T, et al. The efficacy and safety of simultaneous integrated dose reduction in clinical target volume with intensity-modulated radiotherapy for patients with locally advanced esophageal squamous cell carcinoma[J]. Ann Transl Med, 2020, 8(18): 1160. doi: 10.21037/atm-20-4366
|
| [18] |
Tan L, Cheng D, Wen J, et al. Identification of prognostic hypoxia-related genes signature on the tumor microenvironment in esophageal cancer[J]. Math Biosci Eng, 2021, 18(6): 7743-7758. doi: 10.3934/mbe.2021384
|
| [19] |
Zhou X, You M, Wang F, et al. Multifunctional Graphdiyne-Cerium Oxide Nanozymes Facilitate MicroRNA Delivery and Attenuate Tumor Hypoxia for Highly Efficient Radiotherapy of Esophageal Cancer[J]. Adv Mater, 2021, 33(24): e2100556. doi: 10.1002/adma.202100556
|
| [20] |
Hulshof MCCM, Geijsen ED, Rozema T, et al. Randomized study on dose escalation in definitive chemoradiation for patients with locally advanced esophageal cancer (ARTDECO Study)[J]. J Clin Oncol, 2021, 39(25): 2816-2824. doi: 10.1200/JCO.20.03697
|
| [21] |
Lin FC, Chang WL, Chiang NJ, et al. Radiation dose escalation can improve local disease control and survival among esophageal cancer patients with large primary tumor volume receiving definitive chemoradiotherapy[J]. PLoS One, 2020, 15(8): e0237114. doi: 10.1371/journal.pone.0237114
|
| [22] |
Favareto SL, Sousa CF, Pinto PJ, et al. Clinical Prognostic Factors for Patients With Esophageal Cancer Treated With Definitive Chemoradiotherapy[J]. Cureus, 2021, 13(10): e18894.
|
| [23] |
Matsumoto S, Wakatsuki K, Nakade H, et al. Impact of CT-assessed changes in tumor size after neoadjuvant chemotherapy on pathological response and survival of patients with esophageal squamous cell carcinoma[J]. Langenbecks Arch Surg, 2022, 407(3): 965-974. doi: 10.1007/s00423-022-02430-x
|
| [24] |
Wongwaiyut K, Ruangsin S, Laohawiriyakamol S, et al. Pretreatment Esophageal Wall Thickness Associated with Response to Chemoradiotherapy in Locally Advanced Esophageal Cancer[J]. J Gastrointest Cancer, 2020, 51(3): 947-951. doi: 10.1007/s12029-019-00337-3
|
| [25] |
Li TT, Fu XB, Xiao LH, et al. The long-term impact of tumor burden in pT3N0M0 esophageal squamous cell carcinoma: A propensity score-matched analysis[J]. Medicine (Baltimore), 2019, 98(42): e17637. doi: 10.1097/MD.0000000000017637
|
| [26] |
Yue YT, Li N, Shahid H, et al. Gross Tumor Volume Definition and Comparative Assessment for Esophageal Squamous Cell Carcinoma From 3D 18 F-FDG PET/CT by Deep Learning-Based Method[J]. Front Oncol, 2022, 12: 799207. doi: 10.3389/fonc.2022.799207
|
| [27] |
Chen Y, Huang Q, Chen J, et al. Primary gross tumor volume is prognostic and suggests treatment in upper esophageal cancer[J]. BMC Cancer, 2021, 21(1): 1130. doi: 10.1186/s12885-021-08838-w
|
| [28] |
Huang RH, Guo H, Chen JZ, et al. Intratreatment Tumor Volume Change During Definitive Chemoradiotherapy is Predictive for Treatment Outcome of Patients with Esophageal Carcinoma[J]. Cancer Manag Res, 2020, 12: 7331-7339. doi: 10.2147/CMAR.S246500
|
| [29] |
Li SH, Rau KM, Lu HI, et al. Pre-treatment maximal oesophageal wall thickness is independently associated with response to chemoradiotherapy in patients with T3-4 oesophageal squamous cell carcinoma[J]. Eur J Cardiothorac Surg, 2012, 42(6): 958-964. doi: 10.1093/ejcts/ezs136
|
| [30] |
Wu Y, Li J. Change in Maximal Esophageal Wall Thickness Provides Prediction of Survival and Recurrence in Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy and Surgery[J]. Cancer Manag Res, 2021, 13: 2433-2445. doi: 10.2147/CMAR.S295646
|
| [31] |
Chen CZ, Chen JZ, Luo T, et al. Late Toxicities, Failure Patterns, Local Tumor Control, and Survival of Esophageal Squamous Cell Carcinoma Patients After Chemoradiotherapy With a Simultaneous Integrated Boost: A 5-Year Phase Ⅱ Study[J]. Front Oncol, 2021, 11: 738936. doi: 10.3389/fonc.2021.738936
|
| [32] |
Chen Y, Zhu HP, Wang T, et al. What is the optimal radiation dose for non-operable esophageal cancer? Dissecting the evidence in a meta-analysis[J]. Oncotarget, 2017, 8(51): 89095-89107. doi: 10.18632/oncotarget.18760
|
| [33] |
Xu Y, Dong B, Zhu W, et al. A phase III multicenter randomized clinical trial of 60 Gy vs. 50 Gy radiation dose in concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma[J]. Clin Cancer Res, 2022, 28(9): 1792-1799. doi: 10.1158/1078-0432.CCR-21-3843
|
| [34] |
Fokas E, Martin D, Rödel C. Radiotherapy dose escalation does not improve local control in patients with esophageal cancer after definitive radiochemotherapy: the ARTDECO randomized phase Ⅲ trial[J]. Strahlenther Onkol, 2022, 198(4): 397-399. doi: 10.1007/s00066-022-01906-5
|
| [35] |
Luo HS, Huang HC, Lin LX, et al. Effect of modern high-dose versus standard-dose radiation in definitive concurrent chemo-radiotherapy on outcome of esophageal squamous cell cancer: a meta-analysis[J]. Radiat Oncol, 2019, 14(1): 178. doi: 10.1186/s13014-019-1386-x
|
Figures(4) / Tables(4)
This work is licensed under a Creative Commons Attribution 3.0 License.
Copyright © Editorial Department of Cancer Prevention Research 鄂公网安备 42011102005013号 鄂ICP备2022015867号
Supported by: Beijing Renhe Information Technology Co., Ltd. 
DownLoad: