Impact of intensity-modulated radiotherapy on survival and pulmonary toxicities for localized esophageal squamous cell carcinoma

Clinical Snapshot

Key Findings

• P Value: P = 0.034 for IMRT effect on OS; P < 0.001 for clinical stage effect

• Effect Size: IMRT associated with improved overall survival (multivariate P = 0.034)

• Primary Outcome: 2-year overall survival: 40.4%

• Nnt Or Sensitivity: Complete response rate: 40.2%; Pulmonary toxicity significantly lower with IMRT (P = 0.049)

• Confidence Interval: Not reported

Clinical Application

IMRT requires specialized equipment and expertise available in major cancer centres Relevant to Australian practice where IMRT is PBS-funded for esophageal cancer; aligns with Cancer Australia guidelines recommending advanced radiotherapy techniques for improved outcomes Patients with localized esophageal squamous cell carcinoma suitable for definitive chemoradiotherapy

Abstract

OBJECTIVE: Definitive chemoradiotherapy (CRT) is a treatment strategy for localized esophageal squamous cell carcinoma (ESCC). Herein, we aimed to evaluate clinical outcomes of definitive CRT for ESCC. METHODS: We reviewed 127 patients who received definitive CRT for localized ESCC at our institution between January 2004 and December 2022. All patients received elective nodal irradiation with concurrent chemotherapy, primarily comprising cisplatin and 5-fluorouracil, during radiotherapy. Seventeen patients (13%) received intensity-modulated radiation therapy (IMRT) only, and 16 patients (13%) were treated with IMRT as a boost. The median total dose was 61.4 Gy. Approximately 80% of the patients had clinical stage III or higher disease. We analyzed overall survival (OS), progression-free survival (PFS), locoregional recurrence rate (LRR), prognostic factors, and adverse events. RESULTS: The median follow-up period was 13 months for all patients and 22 months for survivors. The 2-year OS, PFS, and LRR were 40.4%, 27.1%, and 30.8%, respectively. The overall complete response rate was 40.2%. On multivariate analysis, clinical stage 0-III (non-T4) (P < .001) and the use of IMRT (P = .034) were significantly associated with better OS. Pulmonary toxicity was significantly lower in the IMRT group (P = .049). CONCLUSIONS: IMRT for localized ESCC may improve prognosis and reduce pulmonary toxicity.

References

1. 1.Torii, A., Tomita, N., Takaoka, T., Sato, T., Kondo, T., Okazaki, D., Niwa, M., Kita, N., Takano, S., Oguri, M., Tsuzuki, H., Hayakawa, S., Ogawa, R., Kubota, E., Takiguchi, S., Kataoka, H., & Hiwatashi, A. (2026). Impact of intensity-modulated radiotherapy on survival and pulmonary toxicities for localized esophageal squamous cell carcinoma. Japanese Journal of Clinical Oncology. https://doi.org/10.1093/jjco/hyag021