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Involved-Field Irradiation Versus Elective Nodal Irradiation in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemoradiotherapy #MMPMID41319202
Zhou X; Liu Y; Zhu J; Li J; Wang Y; Huang G; Peng L; Han Y; Leng X; Wang C; He W; Wu L; Wang Q
Cancer Med 2025[Dec]; 14 (23): e71392 PMID41319202show ga
BACKGROUND: The method of lymph node (LN) irradiation for locally advanced esophageal squamous cell carcinoma (LA-ESCC) is still a topic of debate. We investigated the efficacy, toxicity, and rate of out-of-field LNs in irradiation across different target areas in patients with LA-ESCC undergoing neoadjuvant chemoradiotherapy (nCRT). METHODS: We retrospectively reviewed patient records from June 2017 to August 2022 and divided patients into elective nodal irradiation (ENI) and involved-field irradiation (IFI) groups. The differences in hematological and non-hematological toxicities of the out-of-field LNs were analyzed between the two groups. The log-rank test was used to evaluate the Kaplan-Meier curves for overall and progression-free survival. RESULTS: Among the 306 included patients, 202 (66.0%) received ENI and 104 (34.0%) received IFI. At the 3-year follow-up, the survival rate did not differ significantly between the groups (p > 0.05). Although the occurrence of radiation-induced pneumonia did not differ (p > 0.05), the incidence of radiation-induced esophagitis and the degree of leukopenia differed significantly (p < 0.05). While the average heart irradiation dose or heart V(20), V(30), and V(40) did not differ significantly (p > 0.05), we observed significant differences in the clinical target volume, average lung irradiation dose, and lung V(20), V(30), and V(40) (p < 0.05). Among all patients, 29 cases (9.5%) experienced out-of-field LNs with 26 (93.1%) in abdominal LNs, whereas only 3 cases (6.9%) with out-of-field LNs were in the upper esophagus. There was no statistical significance between out-of-field LNs and LN irradiation methods (p = 0.724). CONCLUSIONS: Under similar prognostic conditions, IFI resulted in mild toxicity compared to ENI. Therefore, for patients with ESCC undergoing nCRT, IFI is the preferred irradiation approach for the lymphatic drainage area.
Cancer+Med 2025 ; 14 (23): e71392
