ArticleThe Annals of thoracic surgery2019
Induction Radiation Therapy for Esophageal Cancer: Does Dose Affect Outcomes?
Article in The Annals of thoracic surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 21 citations in OpenAlex.
- Higher Neoadjuvant Radiation Dose is Associated with Lower Overall Survival in Resected Esophageal Cancer: A Propensity-Matched National Cancer Database Analysis.Annals of surgical oncology · 2025Article
- Preoperative Chemoradiotherapy for Esophageal Carcinoma: A Single-Center 10-Year Experience of Low Versus High-Dose Neoadjuvant Chemoradiation.Annals of surgical oncology · 2025Article
- Effect of Adjuvant Radiation Dose on Survival in Patients with Esophageal Squamous Cell Carcinoma.Cancers · 2022Article
- Prognostic Effect of the Dose of Radiation Therapy and Extent of Lymphadenectomy in Patients Receiving Neoadjuvant Chemoradiotherapy for Esophageal Squamous Carcinoma.Journal of clinical medicine · 2022Article
- Efficacy and Safety of Simultaneous Integrated Boost Intensity-Modulation Radiation Therapy Combined with Systematic and Standardized Management for Esophageal Cancer.Frontiers in surgery · 2022Article
- Gross Tumor Volume Predicts Survival and Pathological Complete Response of Locally Advanced Esophageal Cancer After Neoadjuvant Chemoradiotherapy.Frontiers in oncology · 2022Article
- Recent Progress in the Neoadjuvant Treatment Strategy for Locally Advanced Esophageal Cancer.Cancers · 2021Review
- Optimal radiation dose in the neoadjuvant management of esophageal cancer.Journal of thoracic disease · 2020Article
- Impact of Radiation Dose on Survival for Esophageal Squamous Cell Carcinoma Treated With Neoadjuvant Chemoradiotherapy.Frontiers in oncology · 2020Article
- Radiation doses in esophageal cancer.Journal of thoracic disease · 2019Article
- For radiation therapy before surgery in esophageal cancer, dose matters, and with each answer comes more questions.Journal of thoracic disease · 2019Article
- Neoadjuvant radiation therapy for esophageal cancer: is a higher dose better?Journal of thoracic disease · 2019Article
- Prognostic significance of lung radiation dose in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy.Radiation oncology (London, England) · 2019Article
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11 authors at 1 institution in 1 country.
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Abstract
backgroundWide variation is seen in the dosage of preoperative induction radiation therapy for esophageal cancer. We investigated associations between outcomes after esophagectomy and dosage of induction radiation therapy.
methodsPatients undergoing induction radiation therapy (30 to 70 Gy), followed by esophagectomy, were identified from the National Cancer Database and classified as low (<40 Gy), standard (40 to 50.4 Gy), and high dose (>50.4 Gy). Perioperative outcomes and overall survival were compared. Subgroup analysis compared two common dosages: 45 Gy and 50.4 Gy.
resultsFrom 2004 to 2014, 10,738 patients (84.7%) received standard-dose radiation, increasing from 69.7% in 2004 to 93.6% in 2014 (p < 0.001), 1,329 (10.5%) received low-dose radiation, and 608 (4.8%) received high-dose radiation. Higher rates of pathologic complete response (pCR; low: 11.7%, standard: 16.2%, high: 21.0%; p < 0.001) and downstaging (low: 52.0%, standard: 56.4%, high: 63.1%, p = 0.001) were observed as the dosage increased. On multivariable analysis, compared with standard-dose, high-dose radiation was associated with higher 30-day mortality (odds ratio [OR], 2.11; p < 0.001) without a higher likelihood of downstaging or pCR. Low-dose radiation was associated with lower likelihood of downstaging (OR, 0.85; p = 0.04) and pCR (OR, 0.67; p < 0.001) without lowering the risk of 30-day mortality. The dose of 50.4 Gy was associated with higher likelihood of pCR (OR, 1.12; p = 0.04), without affecting 30-day mortality, compared with 45 Gy.
conclusionsHigh-dose induction radiation (>50.4 Gy) is associated with increased perioperative death after esophagectomy, without a significant improvement in tumor response. Low-dose radiation (<30 Gy) is associated with worse tumor response without a lower risk of perioperative death. Within standard dosages, 50.4 Gy is associated with higher likelihood of pCR without adversely affecting perioperative mortality compared with 45 Gy.
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