Esophageal Cancer Clinical Trial
Official title:
Salvage Chemoradiation Therapy for Recurrence After Radical Surgery or Palliative Surgery in Esophageal Cancer Patients: A Prospective, Multicenter Clinical Trial
Currently, adjuvant therapy is not recommended for patients with esophageal squamous cell carcinoma who received radical surgery. However, the recurrence rate is as high as 23.8%-58%, and the median time-to-recurrence is about 10.5 months. In patients who had residual tumor after surgery, evidence lacks for chemoradiation. The aim of the study is to evaluate the efficacy and safety of chemoradiation therapy in patients with recurrences after radical surgery or palliative surgery.
Currently, adjuvant therapy is not recommended for patients with esophageal squamous cell
carcinoma who received surgery as their first treatment. However, the recurrence rate is as
high as 23.8%-58%, and the median time-to-recurrence is about 10.5 months. In patients who
had residual tumor after surgery, evidence lacks for chemoradiation.
Retrospective data of 218 cases in our hospital indicated patients underwent salvage
chemoradiation had significantly improved survival compared with chemotherapy, radiotherapy
or best supportive care. For patients with locoregional recurrence, the 1-, 3-year overall
survival (OS) rates were statistically higher in patients received salvage chemoradiation
than radiotherapy (1-year OS, 70.0% vs. 55.2%, 3-year OS, 41.9% vs. 23.5%, p=0.045). Patients
received chemotherapy had 1-year OS of 0%.
Data of 218 cases of our hospital indicated patients received radiation dose > 54Gy had a
significantly longer median overall survival time of 21.2 months compared with 11.3 months in
patients had <54Gy. The optimal radiation dose should be further investigated.
The recurrence pattern of patients with esophageal cancer after esophagectomy mainly consist
of supraclavicular and mediastinal lymph nodes. For patients recurred after radical surgery,
prophylactic irradiation to high-risk lymph node regions should be considered. The study use
simultaneously integrated boost (SIB) intensity-modulated radiation therapy (IMRT) in this
trial, which made different radiation dose to recurrent tumor and high-risk lymph node
regions possible.
The aim of the study is to evaluate the efficacy and safety of chemoradiation therapy in
patients with recurrences after radical surgery or palliative surgery. Patients were further
assigned to receive elective field irradiation (ENI) or involved field irradiation (IFI)
according to tumor size, tumor location and time-to-recurrence.
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