Toxicity and treatment outcomes in dose escalated radiotherapy for upper third oesophageal carcinoma
Win, M Barker, Claire L Bhatt, Lubna Sheikh, Hamid Y Radhakrishna, Ganesh
Win, M
Barker, Claire L
Bhatt, Lubna
Sheikh, Hamid Y
Radhakrishna, Ganesh
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Abstract
Purpose or Objective
The incidence of the carcinoma of the upper third oesophagus is rare, accounting for 11% of all oesophageal cancer cases
in the UK. Definitive chemo-radiotherapy (dCRT) is the recommended treatment option in patients with the carcinoma of
the upper third oesophagus. This “real-world” data aimed to provide the treatment outcomes and toxicity for patients
treated with dose-escalated radiotherapy (RT) for upper third oesophageal cancer.
Materials and Methods
This was a retrospective study of patients treated at the Christie Hospital between 2010 and 2021. 44 patients (male=24,
female =20) were identified with squamous cell carcinoma of the upper third oesophagus. RT was delivered using either IG
-IMRT or VMAT with 60-67 Gy in 30 fractions with daily volumetric imaging. 40 Patients received concurrent chemotherapy
including 31 patients who were also given induction chemotherapy. The regimes were platinum based, with 2 patients
receiving cetuximab.
Results
Median age at treatment was 63 (range 27-79). All patients completed 30 fractions of RT. Grade 3 toxicities (CTCAE version
5) were observed in 12 patients (27%): oesophagitis in 7 patients (16%) with 3 patients requiring emergency gastrostomy
insertion, nausea and vomiting in 3 patients (7%) and non-neutropenic sepsis in 2 patients (4%). The 30-day mortality and
90-day mortality rates were 2% and 7% respectively. 50% of patients at 6 month follow-up had subjective improvement in
dysphagia.
At a median follow-up of 19 months (0-83months), 6 patients (14%) developed local relapse in the high dose radiotherapy
field and 14 patients (32%) developed distant metastases. Median overall survival (OS) was 23 months. OS at 1 and 2 year
were 78% and 48% respectively. Median progression-free survival (PFS) was 15 months and PFS at 1 year and 2 year were
53% and 38% respectively. Data will be matured at the time of presentation.
Conclusion
This study demonstrates that dose-escalated RT of 60-67Gy has an acceptable safety profile and offers improved local
disease control in patients with upper third oesophageal cancer. Further studies on dose escalated RT in upper third
oesophageal cancer are required.
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Win MMN, Barker C, Bhatt L, Sheikh H, Radhakrishna G. Toxicity and treatment outcomes in dose escalated radiotherapy for upper third oesophageal carcinoma. Radiotherapy and Oncology. 2022 May;170:S1087-S. PubMed PMID: WOS:000806779900112.