Title

Extended vs. Small Field Irradiation in High Risk Post Esophagectomy Patients Receiving Combined Chemoradiation Therapy: A Decade Experience in Treatment of Esophageal Cancer

Authors

Edward Yu, University of Western OntarioFollow
Patricia Tai, Allan Blair Centre, Regina, SK
George Rodrigues, University of Western OntarioFollow
Robert Ash, London Health Science Centre, London, ON
Larry Stitt, University of Western OntarioFollow
Rashid A. Dar, University of Western OntarioFollow
Pauline Truong, B.C. Cancer Agency, Victoria, BC
Gregory M. Videtic, Cleveland Clinic Foundation, Cleveland, OH
Richard Malthaner, University of Western OntarioFollow
Richard Inculet, University of Western OntarioFollow
Anna Tomiak, Kingston Regional Cancer Centre, Kingston, ON
Jawaid Younus, University of Western OntarioFollow
Brian Dingle, University of Western OntarioFollow
Walter Kocha, London Health Science Centre, London, ON
Mark Vincent, University of Western OntarioFollow

Document Type

Presentation

Publication Date

2005

Abstract

OBJECTIVE: To assess the impact of extended field irradiation with anastomotic coverage on local recurrence in high risk resected esophageal cancerpatients.

METHODS: From 1989-1999, high risk resected esophageal cancer cases receiving post-resection chemoradiation were reviewed. Adjuvant chemotherapy consisted of four cycles of fluorouracil-based regimens. Loco-regional irradiation with or without coverage of anastomotic site had radiation a dose range from 45-60 Gyat 1.8-2.0 Gy/fraction given with initial anterior-posterior/posterior-anterior arrangement with either extended (with anastomotic coverage), or small (without anastomotic coverage) field followed by oblique fields for boost.

RESULTS: One hundred eighty-eight charts were reviewed. Seventy-two patients were eligible for post-resection chemoradiation. Three patients had disease progression prior to therapy, and 69 patients were analyzed. The median age was 60 years (range 35-82 years) with 94% T2-3N1 and 65% were adenocarcinoma. As of January 2005 median followup was 30.5 months (range 3-142 months), the two-and five-year overall survival rates were 50% and 31%, respectively. First relapse rate after adjuvant therapy was 71% (n=49) and median time to relapse was about 30 months. Loco-regional relapse with small field was 25/35 (71.4%) and 2/14 (14.2%) with extended field (P<0.001). Recurrence locally to anastomosis or adjacent site was 10/35 (28.6%) with small field and 0/14 (0%) with extended field (P=0.04).

CONCLUSION: At a minimum of 5-year followup, there is significant decrease in loco-regional relapse with the use of extended field in high risk resected esophageal cancer patients. This important improvement trend deserves further exploration in prospective randomized clinical trials.

Notes

Presentation at the Canadian Association of Radiation Oncologists (CARO) Annual Scientific Meeting in Victoria, BC in 2005