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advanced esophageal cancer patients treated with total
dose of 40 Gy/2.5Gy.
Material and Methods
we retrospectively reviewed the records of 19 patients
diagnosed with locally advanced or metastatic esophageal
cancer, treated in our institution from 2012 to 2015 with
palliative EBRT. All patients had histologically confirmed
diagnosis of squamous cell or adenocarcinoma of the
esophagus and were symptomatic for dysphagia. Before
the start of EBRT the dysphagia was scored according to
scale 0-4 (0- no dysphagia , 1 -dysphagia with certain solid
foods , 2 -able to swallow semi-solid soft foods , 3-able to
swallow liquids only and 4 - unable to swallow saliva ).
The prescribed total dose to all patients was 40Gy with
daily dose of 2.5Gy, 5 fractions per week in sixteen
fractions using Volumetric Modulated Arc technique . We
evaluated the dysphagia score one months after the end
of the EBRT.
Results
Grade 1 dysphagia was detected before RT treatment in 3
patients ( 15.8%), grade 2 in 8 patients (42.2%), grade 3 in
6 patients (31.5%) and grade 4 in 2 patients (10.5%).No
patient discontinued RT due to acute toxicity.
One month after the end of the EBRT 4 patients(21%)
experienced complete dysphagia relief.
Fourteen patients (73.7%) experienced improvement of
symptomatic
dysphagia.
Four patients(21%) had no positive effect and one patient
died 3 weeks after the end of treatment.
Conclusion
EBRT with mild hypofractionation is an effective
treatment for esophageal cancer patients with
symptomatic dysphagia. It is well tolerated and can
provide symptom relief and quality of life improvement.
EP-1243 A Study on predictive value of 18F-FDG PET-
CT to Chemoradiation of Esophageal Cancer
J. Li
1
, W. Sun
2
1
Fujian Cancer Hospital, radiation oncology, Fuzhou-
Fujian, China
2
Fujian medical university, Provincial Clinical College,
Fuzhou, China
Purpose or Objective
To evaluate whether the SUVmax and MTV predict short-
term clinical curative effect of radiotherapy or
chemoradiotherapy in nonoperative esophageal squamous
cell cancer.
Material and Methods
A retrospective analysis was made on 98 cases patients
with esophageal cancer from January 2014 to January
2016 in Fujian Provincial Cancer Hospital. All of them had
an examination by FDG PET/CT before treatment.
Respectively analysis was conducted on SUVmax, MTV's
relationship with clinical factors and short-term clinical
curative effect.
Results
There is no difference on SUVmax and MTV of different
group of age, gender, morbid position and histology
differentiated degree (P > 0.05). Significant difference
was found on SUVmax and MTV of different group of lesion
length, T grade, stage pathologic N stage and clinical (P <
0.05). And positive correlation was noticed between the
SUVmax, MTV and lesion length, T grade, stage pathologic
N stage and clinical stage (P < 0.05). Low MTV group and
low SUVmax group were higher than high MTV group and
high SUVmax group on the percentage of lesion length
reduction(P < 0.05). And it was negative correlation
between SUVmax , MTV and the percentage of lesion
length reduction, but the correlation of MTV was stronger
than SUVmax.
Conclusion
there was no significant effect on SUVmax and MTV for
age, gender, morbid position and histology differentiated
degree (P > 0.05), but lesion length, T grade, pathologic N
stage and clinical stage were significantly positive
correlated with SUVmax and MTV. The SUVmax and MTV
can predict short-term clinical curative effect of
radiotherapy or chemoradiotherapy in nonoperative
esophageal squamous cell cancer, but MTV was more
valuable than
SUVmax .
EP-1244 Neoadjuvant Chemo Radiation followed by
Surgery in Ca Esophagus – Retrospective Review from
India
V. Goel
1
, A.K. Anand
1
, H.K. Chaturvedi
2
, A. Verma
1
, P.
Agarwal
1
, T. Saxena
1
, R. Shukla
1
, D. Arora
3
, A.K. Bansal
3
,
A. Gulia
1
, C. Garg
1
, U. Mukherjee
4
1
Max superspecality hospital, Radiation Oncology, Delhi,
India
2
Max superspecality hospital, Surgical Oncology, Delhi,
India
3
Max superspecality hospital, Medical Physics, Delhi,
India
4
Max superspecality hospital, Pathology, Delhi, India
Purpose or Objective
Neo-adjuvant Concurrent Chemoradiation (NACCRT)
followed by Surgery is now the standard of care for middle
& lower third esophageal carcinoma. However this is an
intensive treatment regimen. Often there are concerns
and doubts about its feasibility in Indian population, who
do not have as good nutritional status as western patients.
At our institute we have been following this treatment
approach since 2009 and have analysed our own outcomes
in terms of feasibility, toxicity, mortality and survivals.
Material and Methods
We treated 62 patients with NACCRT followed by surgery
from October 2009 to December 2015 at Max Hospital,
Delhi, India. All patients underwent esophageal
endoscopy, biopsy and PETCT scan for diagnosis and
staging purpose. Inclusion criteria for NACCRT followed by
surgery were, patients with bulky primary tumour,
enlarged lymph nodes (LN) on imaging, adherence to
surrounding organs and clinical suitability for trimodality
therapy. All patients received radiation therapy (RT) with
IMRT technique with single/double agent concurrent
chemotherapy. PET CT was used in target volume
delineation for IMRT in all patients. RT doses were 41.4
Gy/23 fractions and 45 Gy/25 fractions with double &
single agent chemotherapy respectively. Patients
underwent open transthoracic esophagectomy with 2-
Field lymph node dissection; 6-8 weeks after completion
of NACCRT.
Results
Squamous cell carcinoma was present in 82% patients
while only 18% patients had adeno carcinoma. Tumour was
located in Middle, Lower and Lower and GE junction in
50%, 23% and 27% patients respectively.
Total 60/62 (96.8%) patients completed NACCRT. Of these
46 (76.6%) were taken up for surgery. Three patients (5%)
were considered unsuitable for surgery, 13.3% defaulted
for surgery and 5% were lost to follow up after NACCRT.
Resectability rate for patients taken up for surgery was
93.4%. Perioperative death occurred in 3 patients (6.6%).
Pathological complete response was seen in 37.2%
patients. At median follow up of 17.6 months, 3(7%)
patients had a mediastinal nodal recurrence and 12%
developed distant metastases. In all three patients with
nodal recurrence, LN was located in superior
mediastinum. Median disease free survival (DFS) and
overall survival (OS) is not yet reached. The OS in our study
at 1 and 2 year respectively was 76% and 62.8% for all
patients.
Conclusion
NACTRT followed by surgery is feasible in middle and
lower third carcinoma esophagus patients in Indian
population and yields high DFS and OS. Most common
locoregional pattern of failure was in superior mediastinal
nodal station, which needs to be further addressed in