San Antonio, October 19, 2015—For patients with locally advanced esophageal cancer that has spread to the lymph nodes, radiation therapy (RT) that targets only the involved lymph nodes regions results in less toxicity without causing a statistically significant difference in loco-regional lymph nodal recurrence, distant failure and overall survival rates, according to research presented today at the American Society for Radiation Oncology's (ASTRO's) 57th Annual Meeting.

The American Cancer Society estimates that while esophageal cancer makes up approximately one percent of all cancers diagnosed in the U.S., it is far more prevalent in China, with esophageal squamous cell carcinoma (ESCC) being the most common type of esophageal cancer in China. Many patients with ESCC are not diagnosed until the cancer is in an advanced stage.

Chemoradiation (the combination of chemotherapy and radiation therapy) is a standard treatment for locally advanced esophageal cancer (cancer that has spread to the lymph nodes and surrounding tissue). Elective nodal irradiation (ENI)—RT to the tumor and lymph nodes, including uninvolved lymph nodes in the region around the cancerous tumor—is a common form of RT used to treat ESCC. The use of ENI has been controversial due to increased level of irradiation and possible toxicity. This study evaluated the feasibility of reducing the nodal irradiation volume of RT by comparing ENI to involved-field irradiation (IFI)—RT that involves only the regions where the lymph nodes are located.
The prospective, randomized controlled clinical trial included 110 patients with esophageal cancer enrolled from nine cancer centers across China between April 2012 and November 2014. The patients had inoperable, newly diagnosed stage II – stage III thoracic ESCC.

Patients were treated with concurrent chemoradiotherapy and all of the patients received docetaxel (75 mg/m2 on day one) and CDDP (25 mg/m2 on days one-three) every 21 days for two to four cycles. The patients received image-guided radiation therapy (IGRT) in once-daily fractions of 1.8-2Gy to a total dose of 60-66 Gy to the gross tumor volume (GTV) and 50-54 Gy to the clinical target volume (CTV). The patients were randomly divided into two groups; 56 patients received elective nodal irradiation (the ENI group); and 54 patients received involved-field irradiation (the IFI group).

The primary endpoints of the study were toxicities (side effects) and loco-regional lymph nodal recurrence (indicating the cancer had returned to the area and nearby lymph nodes). The secondary end points were distant failure and overall survival (OS).

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