50 Gy recommended dose in concurrent chemoradiotherapy for ESCC
11 May 2022
When considering concurrent chemoradiotherapy (CCRT) in the treatment of patients with esophageal squamous cell carcinoma (ESCC), the 60 Gy dose yields similar survival outcomes but a higher incidence of severe pneumonitis when compared with the lower 50 Gy dose, according to the results of a phase III study.
Patients with pathologically confirmed stage IIA‒IVA ESCC were randomized to receive either conventional fractionated 60 Gy or 50 Gy to the tumour and regional lymph nodes. In addition, they received concurrent weekly chemotherapy (docetaxel 25 mg/m2; cisplatin 25 mg/m2) and two cycles of consolidation chemotherapy (docetaxel 70 mg/m2; cisplatin 25 mg/m2 days 1‒3).
A total of 319 patients were included in the analysis for survival, and the median follow-up was 34.0 months. In the 60-Gy group, the 1- and 3-year locoregional progression-free survival (PFS) rates were 75.6 percent and 49.5 percent, respectively. These rates were similar to those obtained in the 50-Gy group (72.1 percent and 48.4 percent, respectively; hazard ratio [HR], 1.00, 95 percent confidence interval [CI], 0.75‒1.35; p=0.98).
Likewise, there was no difference seen in other survival endpoints. The overall survival rates were 83.7 percent at 1 year and 53.1 percent at 3 years in the 60 Gy group as opposed to 84.8 percent and 52.7 percent, respectively, in the 50 Gy group (HR, 0.99, 95 percent CI, 0.73‒1.35; p=0.96). Finally, the PFS rates were 71.2 percent and 46.4 percent versus 65.2 percent and 46.1 percent, respectively (HR, 0.97, 95 percent CI, 0.73‒1.30; p=0.86).
Grade 3 and above radiotherapy pneumonitis occurred more frequently in the 60-Gy group than in the 50-Gy group (p=0.03).
The findings indicate that 50 Gy should be considered as the recommended dose in CCRT for ESCC.