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Accelerated fractionation in cancers of the esophagus: a multivariate analysis on 102 patients

Abstract

Purpose: Clinical outcome of cancer of the esophagus treated with conventional fractionated radiotherapy is dismal. Locoregional recurrences remain a major unresolved issue. Although data are scarce, potential doubling times of the squamous cell carcinoma of the esophagus appear to be generally rather short. Accelerated fractionation was used to shorten the conventional overall treatment time by two and half weeks (38% reduction of the treatment time) to counteract possible tumor cell repopulation. Materials and Methods: 102 patients with cancer of the esophagus not submitted to surgery for medical reasons or because of extensive disease. (locoregional or metastases) were entered in the study between 1986 and 1993. There were 27T1, 36T2 and 39T3 tumors, 10% of which were already metastatic. 89% of the patients had a squamous cell carcinoma and 11% an adenocarcinoma. Loss of weight about superior or equal to 10% occurred in 39% of the patients. In 63% of the cases neoadjuvant chemotherapy was given prior to radiation treatment. Radiation treatment delivered a mean dose of 66 Gy (SE=6.4), median dose of 65 Gy. The mean overall treatment time was 32.6 days (SE=6.2), median 31 days. A concomitant boost was used during the basic wide field irradiation to accelerate treatment.  More>>
Publication Date:
Jul 01, 1995
Product Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 32; Journal Issue: 971; Other Information: Copyright (c) 1995 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); PBD: 1995
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; DELAYED RADIATION EFFECTS; ESOPHAGUS; FRACTIONATED IRRADIATION; METASTASES; MULTIVARIATE ANALYSIS; RADIATION DOSES; RADIOTHERAPY; SURVIVAL TIME; TOXICITY
OSTI ID:
20420762
Country of Origin:
United States
Language:
English
Other Identifying Numbers:
Journal ID: ISSN 0360-3016; IOBPD3; TRN: US03R2004005167
Submitting Site:
INIS
Size:
page(s) 266
Announcement Date:

Citation Formats

Girinsky, T, Marsiglia, H, and Auperin, A. Accelerated fractionation in cancers of the esophagus: a multivariate analysis on 102 patients. United States: N. p., 1995. Web. doi:10.1016/0360-3016(95)97912-K.
Girinsky, T, Marsiglia, H, & Auperin, A. Accelerated fractionation in cancers of the esophagus: a multivariate analysis on 102 patients. United States. doi:10.1016/0360-3016(95)97912-K.
Girinsky, T, Marsiglia, H, and Auperin, A. 1995. "Accelerated fractionation in cancers of the esophagus: a multivariate analysis on 102 patients." United States. doi:10.1016/0360-3016(95)97912-K. https://www.osti.gov/servlets/purl/10.1016/0360-3016(95)97912-K.
@misc{etde_20420762,
title = {Accelerated fractionation in cancers of the esophagus: a multivariate analysis on 102 patients}
author = {Girinsky, T, Marsiglia, H, and Auperin, A}
abstractNote = {Purpose: Clinical outcome of cancer of the esophagus treated with conventional fractionated radiotherapy is dismal. Locoregional recurrences remain a major unresolved issue. Although data are scarce, potential doubling times of the squamous cell carcinoma of the esophagus appear to be generally rather short. Accelerated fractionation was used to shorten the conventional overall treatment time by two and half weeks (38% reduction of the treatment time) to counteract possible tumor cell repopulation. Materials and Methods: 102 patients with cancer of the esophagus not submitted to surgery for medical reasons or because of extensive disease. (locoregional or metastases) were entered in the study between 1986 and 1993. There were 27T1, 36T2 and 39T3 tumors, 10% of which were already metastatic. 89% of the patients had a squamous cell carcinoma and 11% an adenocarcinoma. Loss of weight about superior or equal to 10% occurred in 39% of the patients. In 63% of the cases neoadjuvant chemotherapy was given prior to radiation treatment. Radiation treatment delivered a mean dose of 66 Gy (SE=6.4), median dose of 65 Gy. The mean overall treatment time was 32.6 days (SE=6.2), median 31 days. A concomitant boost was used during the basic wide field irradiation to accelerate treatment. Results: Acute toxicity was mainly esophageal. Esophagitis grade III was observed in 17% of the patients and lasted 2 to 3 weeks. Radiation treatment was temporarily stopped in 8% of the patients due to esophagitis and was usually resumed a week later. Previous chemotherapy did not seem to significantly increase the occurrence of esophagitis. Of 82 evaluable patients, 56% had complete tumor regression 2 to 4 months after radiation treatment. There was no strict correlation between response after chemotherapy and the subsequent response after radiotherapy. The actuarial 3-year cause specific survival rates for T1, T2, T3 are 34%, 18.5% and 5% respectively. The actuarial 3-year local control rates for T1, T2, T3 are 67%, 43%, and 25% respectively. Late toxicity included esophageal stricture and pulmonary fibrosis in 8% and 9% of the patients respectively. Multivariate analysis found that stage, the Karnofsky index, chemotherapy, and overall treatment time were independent prognostic factors for the cause specific survival. Conclusions: Accelerated fractionation for cancer of the esophagus seems to be useful in small tumors. Chemotherapy was found to be beneficial to patients when cause specific survival was the end point. Overall radiation treatment time was also an independent prognostic factor for the same end point.}
doi = {10.1016/0360-3016(95)97912-K}
journal = {International Journal of Radiation Oncology, Biology and Physics}
issue = {971}
volume = {32}
journal type = {AC}
place = {United States}
year = {1995}
month = {Jul}
}