Impact of Intensity-Modulated Radiotherapy with Concurrent Chemotherapy on Survival for Patients with Cervical Esophageal Carcinoma
Menée à partir de données portant sur 81 patients atteints d'un carcinome de l'œsophage cervical traité entre 1997 et 2013, cette étude compare, du point de vue de la survie globale, l'intérêt de trois protocoles thérapeutiques combinant radiothérapie et chimiothérapie
Purpose/Objectives : We evaluated the impact of consecutive protocols on overall survival (OS) for cervical esophageal carcinoma (CEC). Materials/Methods : All CEC cases treated with definitive radiotherapy (RT) +/- chemotherapy (CTx) from 1997-2013 were reviewed in 3 consecutive protocols : Protocol 1 (P1): two-dimensional radiotherapy (2DRT), 54 Gy/20 fractions [f] with 5-fluorouracil plus either mitomycin C or cisplatin; P2: three-dimensional conformal radiotherapy (3DRT), ≥ 60 Gy/30f + elective nodal irradiation [ENI]) + cisplatin); P3: intensity-modulated radiotherapy (IMRT), ≥60 Gy/30f + ENI + cisplatin. Multivariable analyses (MVA) assessed the impact of treatment protocol, RT technique and RT dose on OS, separately. Results : Among 81 cases (P1: 21; P2: 23; P3: 37), 34 local (P1: 11 [52%]; P2: 12 [52%], P3: 11 [30%]), 16 regional (P1: 6 [29%); P2: 3 [13%]; P3: 7[19%]), and 34 distant (P1: 10 [48%]; P2: 9 [39%]; P3: 15 [41%]) failures were identified. After adjusting for age (p=0.49) and CTx (any vs. none: HR 0.5 [0.3-0.9], p=0.023), MVA showed P3 had improved OS vs. P1 (HR 0.4 [0.2-0.8], p=0.005) and trended to benefit vs. P2 (HR 0.6 [0.3-1.0], p=0.061); P1 and P2 did not differ (p=0.29). Analyzed as a continuous variable, higher RT doses were associated with a borderline improved OS (HR 0.97 [0.95-1.0], p=0.075). IMRT showed improved OS versus non-IMRT (HR 0.57 [0.3-0.8], p=0.008). Conclusions : This retrospective consecutive cohort study showed improved OS with our current protocol (high-dose IMRT with concurrent high-dose cisplatin) compared to historical protocols. Outcomes in CEC remain poor and novel approaches to improve the therapeutic ratio are warranted.