Safety of dose escalation by simultaneous integrated boosting radiation dose within the primary tumor guided by (18)FDG-PET/CT for esophageal cancer

Wen Yu; Xu-Wei Cai; Qi Liu; Zheng-Fei Zhu; Wen Feng; Qin Zhang; Ying-Jian Zhang; Zhi-Feng Yao; Xiao-Long Fu

doi:10.1016/j.radonc.2014.12.007

Safety of dose escalation by simultaneous integrated boosting radiation dose within the primary tumor guided by (18)FDG-PET/CT for esophageal cancer

Radiother Oncol. 2015 Feb;114(2):195-200. doi: 10.1016/j.radonc.2014.12.007. Epub 2015 Jan 10.

Authors

Wen Yu¹, Xu-Wei Cai¹, Qi Liu², Zheng-Fei Zhu², Wen Feng², Qin Zhang², Ying-Jian Zhang³, Zhi-Feng Yao³, Xiao-Long Fu⁴

Affiliations

¹ Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
² Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
³ Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China.
⁴ Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China; Department of Oncology, Shanghai Medical College, Fudan University, China. Electronic address: xlfu1964@hotmail.com.

PMID: 25586952
DOI: 10.1016/j.radonc.2014.12.007

Abstract

Purpose: To observe the safety of selective dose boost to the pre-treatment high (18)F-deoxyglucose (FDG) uptake areas of the esophageal GTV.

Methods: Patients with esophageal squamous cell carcinoma were treated with escalating radiation dose of 4 levels, with a simultaneous integrated boost (SIB) to the pre-treatment 50% SUVmax area of the primary tumor. Patients received 4 monthly cycles of cisplatin and fluorouracil. Dose-limiting toxicity (DLT) was defined as any Grade 3 or higher acute toxicities causing continuous interruption of radiation for over 1 week.

Results: From April 2012 to February 2014, dose has been escalated up to LEVEL 4 (70Gy). All of the 25 patients finished the prescribed dose without DLT, and 10 of them developed Grade 3 acute esophagitis. One patient of LEVEL 2 died of esophageal hemorrhage within 1 month after completion of radiotherapy, which was not definitely correlated with treatment yet. Late toxicities remained under observation. With median follow up of 8.9months, one-year overall survival and local control was 69.2% and 77.4%, respectively.

Conclusions: Dose escalation in esophageal cancer based on (18)FDG-PET/CT has been safely achieved up to 70Gy using the SIB technique. Acute toxicities were well tolerated, whereas late toxicities and long-term outcomes deserved further observation.

Trial registration: ClinicalTrials.gov NCT01843049.

Keywords: Dose-escalation; Esophageal squamous cell carcinoma; PET/CT; Radiotherapy; Simultaneous integrated boost.

Publication types

Clinical Trial, Phase I

MeSH terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Carcinoma, Squamous Cell / diagnostic imaging*
Carcinoma, Squamous Cell / drug therapy
Carcinoma, Squamous Cell / radiotherapy*
Cisplatin / administration & dosage
Dose-Response Relationship, Radiation
Esophageal Neoplasms / diagnostic imaging*
Esophageal Neoplasms / drug therapy
Esophageal Neoplasms / radiotherapy*
Esophageal Squamous Cell Carcinoma
Female
Fluorodeoxyglucose F18*
Fluorouracil / administration & dosage
Humans
Male
Middle Aged
Multimodal Imaging / methods
Positron-Emission Tomography / methods
Radiopharmaceuticals
Tomography, X-Ray Computed / methods

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18
Cisplatin
Fluorouracil

Associated data

ClinicalTrials.gov/NCT01843049