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Low- vs. High-Dose Neoadjuvant Radiation in Trimodality Treatment of Locally Advanced Esophageal Cancer.

Publication ,  Journal Article
Ji, KSY; Thomas, SM; Roman, SA; Czito, B; Anderson, KL; Frakes, J; Adam, MA; Sosa, JA; Robinson, TJ
Published in: J Gastrointest Surg
May 2019

BACKGROUND: The optimal dose of neoadjuvant radiation for locally advanced, resectable esophageal cancer remains controversial in the absence of randomized clinical trials, with conventional practice favoring the use of 50.4 vs. 41.4 Gy. METHODS: Retrospective analysis of adults with non-metastatic esophageal cancer in the National Cancer Database (2004-2015) treated with neoadjuvant chemoradiotherapy. Outcomes were compared between patients undergoing 41.4, 45, or 50.4 Gy. Primary outcome was overall survival. Secondary outcomes included T and N downstaging and perioperative mortality adjusted for demographics, clinicopathologic factors, and facility volume. RESULTS: Eight thousand eight hundred eighty-one patients were included: 439 (4.9%) received low-dose (41.4 Gy), 2194 (24.7%) received moderate-dose (45 Gy), and 6248 (70.4%) received high-dose (50.4 Gy) neoadjuvant radiation. Compared to high-dose, low-dose radiation was associated with superior median overall survival (52.6 vs. 40.7 months) and 5-year survival (48.3% vs. 40.2%), and lower unadjusted 90-day mortality (2.3% vs. 6.5%, all p ≤ 0.01). Multivariable proportional hazards models confirmed an increased hazard of death associated with high-dose radiation therapy (HR = 1.38, 95% CI 1.10-1.72, p = 0.005). There was no significant difference in T and/or N downstaging between low-dose vs. high-dose therapy (p > 0.1 for both). Patients receiving 45 Gy exhibited the lowest median overall survival (37.2 months) and 5-year survival (38.7%, log-rank p = 0.04). CONCLUSIONS: Compared to 50.4 Gy, 41.4 Gy is associated with reduced perioperative mortality and superior overall survival with similar downstaging in locally advanced esophageal cancer. In the absence of randomized clinical data, our findings support the use of 41.4 Gy in patients with chemoradiation followed by esophagectomy. Prospective trials are warranted to further validate these results.

Duke Scholars

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

May 2019

Volume

23

Issue

5

Start / End Page

885 / 894

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Radiotherapy Dosage
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

APA
Chicago
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MLA
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Ji, K. S. Y., Thomas, S. M., Roman, S. A., Czito, B., Anderson, K. L., Frakes, J., … Robinson, T. J. (2019). Low- vs. High-Dose Neoadjuvant Radiation in Trimodality Treatment of Locally Advanced Esophageal Cancer. J Gastrointest Surg, 23(5), 885–894. https://doi.org/10.1007/s11605-018-4007-3
Ji, Keven S. Y., Samantha M. Thomas, Sanziana A. Roman, Brian Czito, Kevin L. Anderson, Jessica Frakes, Mohamed A. Adam, Julie A. Sosa, and Timothy J. Robinson. “Low- vs. High-Dose Neoadjuvant Radiation in Trimodality Treatment of Locally Advanced Esophageal Cancer.J Gastrointest Surg 23, no. 5 (May 2019): 885–94. https://doi.org/10.1007/s11605-018-4007-3.
Ji KSY, Thomas SM, Roman SA, Czito B, Anderson KL, Frakes J, et al. Low- vs. High-Dose Neoadjuvant Radiation in Trimodality Treatment of Locally Advanced Esophageal Cancer. J Gastrointest Surg. 2019 May;23(5):885–94.
Ji, Keven S. Y., et al. “Low- vs. High-Dose Neoadjuvant Radiation in Trimodality Treatment of Locally Advanced Esophageal Cancer.J Gastrointest Surg, vol. 23, no. 5, May 2019, pp. 885–94. Pubmed, doi:10.1007/s11605-018-4007-3.
Ji KSY, Thomas SM, Roman SA, Czito B, Anderson KL, Frakes J, Adam MA, Sosa JA, Robinson TJ. Low- vs. High-Dose Neoadjuvant Radiation in Trimodality Treatment of Locally Advanced Esophageal Cancer. J Gastrointest Surg. 2019 May;23(5):885–894.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

May 2019

Volume

23

Issue

5

Start / End Page

885 / 894

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Radiotherapy Dosage
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies