Randomized Study on Dose Escalation in Definitive Chemoradiation for Patients With Locally Advanced Esophageal Cancer (ARTDECO Study)
Journal of Clinical Oncology, vol. 39, pp. 2816–2824
Abstract
PURPOSE To analyze the effect of radiation dose escalation to the primary tumor on local tumor control in definitive chemoradiation (dCRT) for patients with esophageal cancer. PATIENTS AND METHODS Patients with medically inoperable and/or irresectable esophageal carcinoma, referred for dCRT, were randomly assigned between a standard dose (SD) of 50.4 Gy/1.8 Gy for 5.5 weeks to the tumor and regional lymph nodes and a high dose (HD) up to a total dose of 61.6 Gy to the primary tumor. Chemotherapy consisted of courses of concurrent carboplatin (area under the curve 2) and paclitaxel (50 mg/m 2 ) in both arms once a week for 6 weeks. The primary end point was local progression-free survival. RESULTS Between September 2012 and June 2018, 260 patients were included. Squamous cell carcinoma (SCC) was present in 61% of patients, and 39% had adenocarcinoma (AC). Radiation treatment was completed by 94%, and 85% had at least five courses of chemotherapy. The median follow-up time for all patients was 50 months. The 3-year local progression-free survival (LPFS) was 70% in the SD arm versus 73% in the HD arm (not significant). The LPFS for SCC and AC was 75% versus 79% and 61% versus 61% for SD and HD, respectively (not significant). The 3-year locoregional progression-free survival was 52% and 59% for the SD and HD arms, respectively ( P = .08). Overall, grade 4 and 5 common toxicity criteria were 12% and 5% in the SD arm versus 14% and 10% in the HD arm, respectively ( P = .15). CONCLUSION In dCRT for esophageal cancer, radiation dose escalation up to 61.6 Gy to the primary tumor did not result in a significant increase in local control over 50.4 Gy. The absence of a dose effect was observed in both AC and SCC.
Authors 15
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Amsterdam University Medical Centers
Affiliation as printed
Department of Radiotherapy, Amsterdam UMC, Amsterdam, the Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Radiotherapy, Amsterdam UMC, Amsterdam, the Netherlands
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Affiliation as printed
Verbeeten Institute, Tilburg, the Netherlands
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Radiotherapeutisch Instituut Friesland
Affiliation as printed
Radiotherapeutisch Instituut Friesland, Leeuwarden, the Netherlands
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Affiliation as printed
Department of Radiation Oncology, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
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Karen J. Neelis Aachen
Leiden University Medical Center
Affiliation as printed
Leids Universitair Medisch Centrum, Leiden, the Netherlands
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Affiliation as printed
Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
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Affiliation as printed
Department of Radiotherapy, Catharina Ziekenhuis, Eindhoven, the Netherlands
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Affiliation as printed
Radiotherapiegroep, Deventer, the Netherlands
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Affiliation as printed
Department of Radiotherapy, Zeeuws Radiotherapeutisch Instituut, Vlissingen, the Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Surgery, Amsterdam UMC, Amsterdam, the Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Biostatistic, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, the Netherlands
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Amsterdam University Medical Centers · Cancer Center Amsterdam
Affiliation as printed
Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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Affiliation as printed
Department of Medical Oncology, Erasmus MC, Rotterdam, the Netherlands
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