Among patients with locally advanced esophageal cancer receiving definitive chemoradiotherapy, radiation dose escalation did not improve local tumor control or survival, according to study results published in the Journal of Clinical Oncology.
The study authors noted that standard therapy for patients with localized esophageal carcinoma is radiation at a dose of 50 Gy given with concurrent chemotherapy. However, this treatment is associated with high rates of locoregional failure.
The researchers conducted the ARTDECO study to determine if radiation dose escalation would improve local tumor control. The trial included 260 patients, of whom 61.9% had squamous cell carcinoma (SCC) and 38.2% had adenocarcinoma.
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The patients were randomly assigned 1:1 to receive the standard radiation dose of 50.4 Gy or a high dose of 61.6 Gy. In the standard-dose arm, patients received 28 fractions of 1.8 Gy for 5.5 weeks. Patients in the high-dose arm received the same regimen, plus a simultaneous boost dose of 0.4 Gy to the primary tumor.
Patients in both arms also received chemotherapy consisting of carboplatin and paclitaxel once a week for 6 weeks.
In all, 85% of patients received at least 5 courses of chemotherapy, and 94% completed radiation — 96% of the standard-dose arm and 91.9% of the high-dose arm.
At a median follow-up of 50 months, there was no significant difference in local progression-free survival (PFS) between the treatment groups (P =.62). The 3-year local PFS rate was 71% in the standard-dose arm and 73% in the high-dose arm.
The 3-year local PFS rate for patients with SCC was 75% in the standard-dose arm and 79% in the high-dose arm. Among patients with adenocarcinoma, the 3-year local PFS rate was 61% in both treatment arms.
The 3-year locoregional PFS rate was 53% in the standard-dose arm and 59% in the high- dose arm (P =.24). The 3-year overall survival rate was 42% and 39%, respectively (P =.22).
There were no significant differences in overall toxicities between the treatment arms.
Grade 4 adverse events (AEs) occurred in 13% of patients in the standard-dose arm and 14% of those in the high-dose arm. Grade 5 AEs occurred in 3% and 8%, respectively.
Grade 5 toxicity related to esophageal bleeding occurred in 1 patient in the standard-dose arm and 3 patients in the high-dose arm.
Because radiation dose escalation did not improve local tumor control or survival in this study, a dose of 50.4 Gy remains the standard dose, the study authors concluded.
Disclosures: This research was supported by the Dutch Cancer Foundation. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Hulshof MCCM, Geijsen ED, Rozema T, et al. Randomized study on dose escalation in definitive chemoradiation for patients with locally advanced esophageal cancer (ARTDECO Study). J Clin Oncol. Published online June 8, 2021. doi:10.1200/JCO.20.03697
