To evaluate the local control, survival, and toxicity associated with three-dimensional
conformal radiotherapy (3D-CRT) for squamous cell carcinoma (SCC) of the esophagus,
to determine the appropriate target volumes, and to determine whether elective nodal
irradiation is necessary in these patients.
A prospective study of 3D-CRT was undertaken in patients with esophageal SCC without
distant metastases. Patients received 68.4 Gy in 41 fractions over 44 days using late-course
accelerated hyperfractionated 3D-CRT. Only the primary tumor and positive lymph nodes
were irradiated. Isolated out-of-field regional nodal recurrence was defined as a
recurrence in an initially uninvolved regional lymph node.
All 53 patients who made up the study population tolerated the irradiation well. No
acute or late Grade 4 or 5 toxicity was observed. The median survival time was 30
months (95% confidence interval, 17.7-41.8). The overall survival rate at 1, 2, and
3 years was 77%, 56%, and 41%, respectively. The local control rate at 1, 2, and 3
years was 83%, 74%, and 62%, respectively. Thirty-nine of the 53 patients (74%) showed
treatment failure. Seventeen of the 39 (44%) developed an in-field recurrence, 18
(46%) distant metastasis with or without regional failure, and 3 (8%) an isolated
out-of-field nodal recurrence only. One patient died of disease in an unknown location.
In patients treated with 3D-CRT for esophageal SCC, the omission of elective nodal
irradiation was not associated with a significant amount of failure in lymph node
regions not included in the planning target volume. Local failure and distant metastases
remained the predominant problems.
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