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Title: Prospective trial of radiotherapy for patients 80 years of age or older with squamous cell carcinoma of the thoracic esophagus

Abstract

Purpose: To assess the safety and efficacy of external beam radiotherapy for elderly patients with esophageal cancer. Methods and Materials: A trial testing external beam radiotherapy (66 Gy within 6.5 weeks) as a single-modality treatment was performed for biopsy-proven squamous cell carcinoma of the thoracic esophagus clinically staged as Stage I and II A (Tz1-Taman, International Union Against Cancer, 1987) in patients aged {>=}80 years. Results: From January 1999 through December 2002, 51 evaluable patients (35 men and 16 women) with a median age of 83 years (range, 80-91 years) were enrolled from 22 institutions. Of the 51 patients, 18 (35%) had Stage Tz1 and 33 (65%) had Stage Tz2-T disease. Radiotherapy could be completed in 47 patients (92%) within 43-58 days (median, 49). The actuarial incidence of Grade 3 or worse cardiopulmonary complications at 3 years was 26%, with 3 early deaths, and correlated significantly with the size of the anteroposterior radiotherapy portals. The median survival time and overall survival rate at 3 years was 30 months and 39% (95% confidence interval, 25-52%), respectively. Conclusion: The results of high-dose radiotherapy in octogenarians are comparable to those in younger patients, but meticulous treatment planning and quality control is required.

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [7];  [8];  [9];  [10];  [11];  [12];  [13];  [14];  [15];  [16];  [4];  [17];  [16];  [2]
  1. Division of Radiation Oncology, National Cancer Center Hospital East, Kashiwa (Japan). E-mail: mkawashi@east.ncc.go.jp
  2. Division of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan)
  3. Department of Radiology, University of the Ryukyus Graduate School of Medical Science, Okinawa (Japan)
  4. Department of Radiology, Chiba University School of Medicine, Chiba (Japan)
  5. Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama (Japan)
  6. Department of Surgery, Kasumigaura Medical Center, Tsuchiura (Japan)
  7. Department of Radiology, Hyogo Medical Center for Adults, Akashi (Japan)
  8. Department of Radiation Oncology, Aichi Cancer Center, Nagoya (Japan)
  9. Department of Surgery, Social Insurance Saitama Hospital, Saitama (Japan)
  10. Department of Radiology, Asahikawa Medical College, Asahikawa (Japan)
  11. Department of Radiology, Shinshu University School of Medicine, Matsumoto (Japan)
  12. Department of Radiation Oncology, Shikoku Cancer Center, Matsuyama (Japan)
  13. Department of Radiology, Ohtsu Red Cross Hospital, Ohtsu (Japan)
  14. Department of Surgery I, Dokkyo University School of Medicine, Shimotsuga (Japan)
  15. Department of Radiation Oncology, Nara Medical University, Nara (Japan)
  16. Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai (Japan)
  17. Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo (Japan)
Publication Date:
OSTI Identifier:
20793390
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 64; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.09.027; PII: S0360-3016(05)02718-5; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BEAMS; BIOPSY; CARCINOMAS; DEATH; ESOPHAGUS; PATIENTS; QUALITY CONTROL; RADIOTHERAPY; SURVIVAL TIME

Citation Formats

Kawashima, Mitsuhiko, Kagami, Yoshikazu, Toita, Takafumi, Uno, Takashi, Sugiyama, Masato, Tamura, Yoichirio, Hirota, Saeko, Fuwa, Nobukazu, Hashimoto, Mitsumasa, Yoshida, Hiroshi, Shikama, Naoto, Kataoka, Masaaki, Akuta, Keizo, Sasaki, Kinro, Tamamoto, Tetsuro, Nemoto, Kenji, Ito, Hisao, Kato, Hoichi, Yamada, Shogo, and Ikeda, Hiroshi. Prospective trial of radiotherapy for patients 80 years of age or older with squamous cell carcinoma of the thoracic esophagus. United States: N. p., 2006. Web. doi:10.1016/J.IJROBP.2005.0.
Kawashima, Mitsuhiko, Kagami, Yoshikazu, Toita, Takafumi, Uno, Takashi, Sugiyama, Masato, Tamura, Yoichirio, Hirota, Saeko, Fuwa, Nobukazu, Hashimoto, Mitsumasa, Yoshida, Hiroshi, Shikama, Naoto, Kataoka, Masaaki, Akuta, Keizo, Sasaki, Kinro, Tamamoto, Tetsuro, Nemoto, Kenji, Ito, Hisao, Kato, Hoichi, Yamada, Shogo, & Ikeda, Hiroshi. Prospective trial of radiotherapy for patients 80 years of age or older with squamous cell carcinoma of the thoracic esophagus. United States. doi:10.1016/J.IJROBP.2005.0.
Kawashima, Mitsuhiko, Kagami, Yoshikazu, Toita, Takafumi, Uno, Takashi, Sugiyama, Masato, Tamura, Yoichirio, Hirota, Saeko, Fuwa, Nobukazu, Hashimoto, Mitsumasa, Yoshida, Hiroshi, Shikama, Naoto, Kataoka, Masaaki, Akuta, Keizo, Sasaki, Kinro, Tamamoto, Tetsuro, Nemoto, Kenji, Ito, Hisao, Kato, Hoichi, Yamada, Shogo, and Ikeda, Hiroshi. Wed . "Prospective trial of radiotherapy for patients 80 years of age or older with squamous cell carcinoma of the thoracic esophagus". United States. doi:10.1016/J.IJROBP.2005.0.
@article{osti_20793390,
title = {Prospective trial of radiotherapy for patients 80 years of age or older with squamous cell carcinoma of the thoracic esophagus},
author = {Kawashima, Mitsuhiko and Kagami, Yoshikazu and Toita, Takafumi and Uno, Takashi and Sugiyama, Masato and Tamura, Yoichirio and Hirota, Saeko and Fuwa, Nobukazu and Hashimoto, Mitsumasa and Yoshida, Hiroshi and Shikama, Naoto and Kataoka, Masaaki and Akuta, Keizo and Sasaki, Kinro and Tamamoto, Tetsuro and Nemoto, Kenji and Ito, Hisao and Kato, Hoichi and Yamada, Shogo and Ikeda, Hiroshi},
abstractNote = {Purpose: To assess the safety and efficacy of external beam radiotherapy for elderly patients with esophageal cancer. Methods and Materials: A trial testing external beam radiotherapy (66 Gy within 6.5 weeks) as a single-modality treatment was performed for biopsy-proven squamous cell carcinoma of the thoracic esophagus clinically staged as Stage I and II A (Tz1-Taman, International Union Against Cancer, 1987) in patients aged {>=}80 years. Results: From January 1999 through December 2002, 51 evaluable patients (35 men and 16 women) with a median age of 83 years (range, 80-91 years) were enrolled from 22 institutions. Of the 51 patients, 18 (35%) had Stage Tz1 and 33 (65%) had Stage Tz2-T disease. Radiotherapy could be completed in 47 patients (92%) within 43-58 days (median, 49). The actuarial incidence of Grade 3 or worse cardiopulmonary complications at 3 years was 26%, with 3 early deaths, and correlated significantly with the size of the anteroposterior radiotherapy portals. The median survival time and overall survival rate at 3 years was 30 months and 39% (95% confidence interval, 25-52%), respectively. Conclusion: The results of high-dose radiotherapy in octogenarians are comparable to those in younger patients, but meticulous treatment planning and quality control is required.},
doi = {10.1016/J.IJROBP.2005.0},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 64,
place = {United States},
year = {Wed Mar 15 00:00:00 EST 2006},
month = {Wed Mar 15 00:00:00 EST 2006}
}
  • Purpose: To determine an optimal standardized uptake value (SUV) threshold for detecting lymph node (LN) metastases in esophageal cancer using {sup 18}F-Fluorodeoxyglucose positron emission tomography/computer tomography ({sup 18}FDG PET/CT) and to define the resulting nodal target volume, using histopathology as a 'gold standard.' Methods: Sixteen patients with esophageal squamous cell carcinoma who underwent radical esophagectomy and three-field LN dissection after {sup 18}FDG PET/CT and CT scans were enrolled into this study. Locations of LN groups were recorded according to a uniform LN map. Diagnostic performance of different SUV thresholds was assessed by receiver operating characteristic analysis. The optimal cutoff SUVmore » was determined by plotting the false-negative rate (FNR) and false-positive rate (FPR), the sum of both error rates (FNR+FPR), and accuracy against a hypothetical SUV threshold. For each patient, nodal gross tumor volumes (GTVNs) were generated with CT alone (GTVNCT), PET/CT (GTVNPET), and pathologic data (GTVNpath). GTVNCT or GTVNPET was compared with GTVNpath by means of a conformity index (CI), which is the intersection of the two GTVNs divided by the sum of them minus the intersection, e.g., CI{sub CT} and {sub path} = GTVN{sub CT} and {sub path}/(GTVN{sub CT}+ GTVN{sub path} - GTVN{sub CT} and {sub path}). Results: LN metastases occurred in 21 LN groups among the 144 specimens taken from the 16 patients. The area under the receiver operating characteristic curve was 0.9017 {+-} 0.0410. The plot of error rates showed a minimum of FNR+FPR for an SUV of 2.36, at which the sensitivity, specificity, and accuracy were 76.19%, 95.93%, and 93.06%, respectively, whereas those of CT were 33.33%, 94.31%, and 85.42% (p values: 0.0117, 0.7539, and 0.0266). Mean GTVN{sub CT}, GTVN{sub PET}, and GTVN{sub path} were 1.52 {+-} 2.38, 2.82 {+-} 4.51, and 2.68 {+-} 4.16cm{sup 3}, respectively. Mean CI{sub CT} and {sub path} and CI{sub PET} and {sub path} were 0.31 and 0.65 (p value = 0.0352). Conclusions: Diagnostic superiority of PET/CT at an SUV threshold of 2.36 over CT has potential value in nodal target volume definition, but whether this can contribute to better treatment outcomes needs prospective analyses of recurrences in a larger cohort of patients.« less
  • Purpose: To determine the optimal method of using {sup 18}F-fluorothymidine (FLT) positron emission tomography (PET)/computed tomography (CT) simulation to delineate the gross tumor volume (GTV) in esophageal squamous cell carcinoma verified by pathologic examination and compare the results with those using {sup 18}F-fluorodeoxyglucose (FDG) PET/CT. Methods and Materials: A total of 22 patients were enrolled and underwent both FLT and FDG PET/CT. The GTVs with biologic information were delineated using seven different methods in FLT PET/CT and three different methods in FDG PET/CT. The results were compared with the pathologic gross tumor length, and the optimal threshold was obtained. Next,more » we compared the simulation plans using the optimal threshold of FLT and FDG PET/CT. The radiation dose was prescribed as 60 Gy in 30 fractions with a precise radiotherapy technique. Results: The mean +- standard deviation pathologic gross tumor length was 4.94 +- 2.21 cm. On FLT PET/CT, the length of the standardized uptake value 1.4 was 4.91 +- 2.43 cm. On FDG PET/CT, the length of the standardized uptake value 2.5 was 5.10 +- 2.18 cm, both of which seemed more approximate to the pathologic gross tumor length. The differences in the bilateral lung volume receiving >=20 Gy, heart volume receiving >=40 Gy, and the maximal dose received by spinal cord between FLT and FDG were not significant. However, the values for mean lung dose, bilateral lung volume receiving >=5, >=10, >=30, >=40, and >=50 Gy, mean heart dose, and heart volume receiving >=30 Gy using FLT PET/CT-based planning were significant lower than those using FDG PET/CT. Conclusion: A standardized uptake value cutoff of 1.4 on FLT PET/CT and one of 2.5 on FDG PET/CT provided the closest estimation of GTV length. Finally, FLT PET/CT-based treatment planning provided potential benefits to the lungs and heart.« less
  • Purpose: Salvage options for unresectable locally recurrent, previously irradiated squamous cell carcinoma of the head and neck (rSCCHN) are limited. Although the addition of reirradiation may improve outcomes compared to chemotherapy alone, significant toxicities limit salvage reirradiation strategies, leading to suboptimal outcomes. We therefore designed a phase 2 protocol to evaluate the efficacy of stereotactic body radiation therapy (SBRT) plus cetuximab for rSCCHN. Methods and Materials: From July 2007 to March 2013, 50 patients >18 years of age with inoperable locoregionally confined rSCCHN within a previously irradiated field receiving ≥60 Gy, with a Zubrod performance status of 0 to 2, and normalmore » hepatic and renal function were enrolled. Patients received concurrent cetuximab (400 mg/m{sup 2} on day −7 and then 250 mg/m{sup 2} on days 0 and +8) plus SBRT (40-44 Gy in 5 fractions on alternating days over 1-2 weeks). Primary endpoints were 1-year locoregional progression-free survival and National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 graded toxicity. Results: Median follow-up for surviving patients was 18 months (range: 10-70). The 1-year local PFS rate was 60% (95% confidence interval [CI]: 44%-75%), locoregional PFS was 37% (95% CI: 23%-53%), distant PFS was 71% (95% CI: 54%-85%), and PFS was 33% (95% CI: 20%-49%). The median overall survival was 10 months (95% CI: 7-16), with a 1-year overall survival of 40% (95% CI: 26%-54%). At last follow-up, 69% died of disease, 4% died with disease, 15% died without progression, 10% were alive without progression, and 2% were alive with progression. Acute and late grade 3 toxicity was observed in 6% of patients respectively. Conclusions: SBRT with concurrent cetuximab appears to be a safe salvage treatment for rSCCHN of short overall treatment time.« less
  • Purpose: In an aging society, many senior citizens want less invasive treatment because of potential medical complications. The National Institute of Radiological Sciences has started to treat stage I lung cancer with single-fraction carbon-ion radiation therapy (CIRT) as a dose escalation prospective phase 1/2 trial. We evaluated the efficacy and safety of CIRT for patients 80 years of age and older, undergoing single-fraction CIRT. Methods and Materials: Peripheral non-small cell lung cancer patients who were treated with single-fraction CIRT were prospectively followed. We analyzed the data from among these patients 80 years of age and older. Results: There were 70 patients. Medianmore » age was 83 years (range: 80-89) and median follow-up period was 42.7 months (range: 12-128 months). Three-year local control, cause-specific survival, and overall survival rates were 88.0%, 81.6%, and 72.4%, respectively. Five-year local control, cause-specific survival, and overall survival rates were 85.8%, 64.9%, and 39.7%, respectively. There were no adverse effects higher than grade 2 either in the acute or late phase in terms of skin and lung. Analgesic agents were necessary for only 5 patients (7.1%), to relieve muscular or rib fracture pain caused by irradiation. Conclusions: Single-fraction CIRT was low-risk and effective, even for the elderly.« less
  • One hundred forty-nine patients with localized nonsmall cell carcinoma of the lung (Stage III A and B) were treated with two monthly cycles of initial chemotherapy that included vindesine-cisplatin followed by 6000 cGy of thoracic irradiation. Patients with complete, partial, and minor response after initial chemotherapy were randomized into groups to receive either maintenance chemotherapy (four cycles) after radiotherapy or radiotherapy alone. The objective response rate was 24% after chemotherapy and 41% after combined chemoradiotherapy (complete response, 7.5%). The overall median survival was 9 months and the 2-year survival was 14%. Survival was identical with or without maintenance chemotherapy. Themore » 2-year survival of patients with complete response was 75% compared with 9% for patients with partial or minor response. These results suggest that only the few patients (ten) who achieve complete response have a strong probability of survival. It is therefore essential to search for other therapeutic modalities that result in an increase of the complete response rate.« less