Abstract 1573P
Background
Concurrent chemoradiation is standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC), while the optimal regimen of radiotherapy, especially in terms of total dose and planned range of target field, remained unclear. We performed this phase III clinical trial (ChiCTR-IPR-15007172) to compare the survival benefits between different radiation dose and different target field.
Methods
This trial compared two radiation treatment aspects of total dose and field under two-by-two factorial design. The involved field irradiation (IFI) group and elective nodal irradiation (ENI) group adopted different radiation plans of clinical target volume. The high radiation dose group (HD) totally received 59.4Gy radiation and standard dose group (SD) received 50.4 Gy. The participants were assigned to one of the four groups (HD+ENI, HD+IFI, SD+ENI and SD+IFI) by simple randomization (1:1:1:1 ratio). The planned sample size was 147 in each arm (588 totally) and the primary endpoint was overall survival (OS). All statistical analysis was performed according to intention-to-treat principle.
Results
The median follow-up time reached 64.6 months up to April 2023. In comparison of target field, patients in IFI or ENI presented similar OS (HR=0.99, log rank test p =0.93) and PFS (HR=1.02). The HD treatment did not present significantly prolonged OS (HR=0.90, log rank test p value=0.318) compared with SD but suggested improved PFS (25.2 months to 18.0 months, HR=0.76). No significant synergistic effect was detected between dose and radiation field in interaction analysis (p=0.11). In subgroup analysis, the HD radiation suggested benefits in T4 tumors, and the ENI treatment was associated with better OS in N0 patients. No significant difference in occurrences of severe adverse events was detected in dose or field comparisons.
Conclusions
The IFI has similar treatment efficiency to ENI, which indicated a reasonable choice for locally advanced ESCC. HD radiation did not suggest significant benefits in OS, but associated with better PFS compared to SD.
Clinical trial identification
ChiCTR-IPR-15007172.
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
This work was supported by the grants of Key Research and Development Program of Shandong Province of China, 2017CXZC1206, National Natural Science Foundation of China, 81874224, Academic promotion program of Shandong First Medical University, China, 2019LJ004, Key Research and Development Program of Shandong Province, 2021LCZX04 and Key Research and Development Program of Shandong Province, 2021SFGC0501.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
1580P - Early onset oesophageal adenocarcinoma: A separate biological entity?
Presenter: Dharmesh Valand
Session: Poster session 22
1581P - Total neoadjuvant chemotherapy with FOLFIRINOX regimen in patients with resectable locally advanced gastric and gastroesophageal junction cancer
Presenter: Maria Sedova
Session: Poster session 22
1582P - Gastroesophageal adenocarcinoma in young adults: Retrospective analysis of clinical and molecular features
Presenter: Daniel Acosta Eyzaguirre
Session: Poster session 22
1583P - Intraperitoneal chemotherapy for peritoneal metastases of gastric origin: A systematic review and meta-analysis
Presenter: Niels Guchelaar
Session: Poster session 22
1585P - The impact of platinum-induced peripheral neuropathy (PN) in first-line treatment on PN and efficacy in second-line paclitaxel (PTX)-based chemotherapy for unresectable advanced gastric cancer (AGC): A prospective observational multicenter study - IVY study
Presenter: Yoshiyasu Kono
Session: Poster session 22
1587P - Analysis of survival outcomes according to start timing of adjuvant chemotherapy in patients with gastric cancer: A retrospective nationwide cohort study
Presenter: Tae-Hwan Kim
Session: Poster session 22
1588P - Analysis of risk factors of anastomotic leakage after minimally invasive esophagectomy with circular cervical anastomosis
Presenter: ming lu
Session: Poster session 22
1589P - Systemic treatment strategies and outcomes of patients with peritoneal metastases of gastric origin
Presenter: Niels Guchelaar
Session: Poster session 22