1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Copyright © 2025 by the Korean Cancer Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This study was approved by the Institutional Review Board of Samsung Medical Center (SMC-2022-11-131) and conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was waived because of the retrospective nature of the study and the analysis used anonymous data.
Author Contributions
Conceived and designed the analysis: Oh D, Ahn YC, Sun JM, Kim HK, Shim YM.
Collected the data: Cho WK, Noh JM, Oh D, Ahn YC, Sun JM, Kim HK, Shim YM.
Contributed data or analysis tools: Cho WK, Noh JM, Oh D, Ahn YC.
Performed the analysis: Cho WK, Noh JM.
Wrote the paper: Cho WK, Noh JM.
Conflict of Interest
Yong Chan Ahn, the editor-in-chief of the Cancer Research and Treatment, was not involved in the editorial evaluation or decision to publish this article. All remaining authors have declared no conflicts of interest.
Characteristic | Total (n=147) | RT alone (n=96) | CCRT (n=51) | p-value |
---|---|---|---|---|
Age (yr) | 65 (41-86) | 67 (41-86) | 64 (43-77) | 0.028 |
Sex | ||||
Female | 9 (6.1) | 6 (6.3) | 3 (5.9) | 0.929 |
Male | 138 (93.9) | 90 (93.8) | 48 (94.1) | |
Location | ||||
Upper | 27 (18.4) | 17 (17.7) | 10 (19.6) | 0.961 |
Middle | 82 (55.8) | 54 (56.3) | 28 (54.9) | |
Lower | 38 (25.8) | 25 (26.0) | 13 (25.5) | |
Performance status | ||||
ECOG 0-1 | 127 (86.4) | 79 (82.3) | 48 (94.1) | 0.047 |
ECOG 2-3 | 20 (13.6) | 17 (17.7) | 3 (5.9) | |
Initial pathologic T category | ||||
pT0-1 | 48 (32.7) | 30 (31.3) | 18 (35.3) | 0.712 |
pT2-4 | 99 (67.3) | 66 (68.7) | 33 (64.7) | |
Initial pathologic N category | ||||
pN0-1 | 106 (72.1) | 66 (68.8) | 40 (78.4) | 0.213 |
pN2-3 | 41 (27.9) | 30 (31.3) | 11 (21.6) | |
Initial stage | ||||
I | 24 (16.3) | 15 (15.6) | 9 (17.6) | 0.896 |
II | 53 (36.1) | 34 (35.4) | 19 (37.3) | |
III | 70 (47.6) | 47 (49.0) | 23 (45.1) | |
Initial adjuvant treatment | ||||
Adjuvant chemotherapy | 57 (38.8) | 36 (37.5) | 21 (41.2) | 0.488 |
No adjuvant treatment | 90 (61.2) | 60 (62.5) | 30 (58.8) | |
Disease-free interval (mo) | 13.5 (1.0-97.4) | 14.3 (1.0-97.4) | 12.5 (1.5-58.2) | 0.557 |
No. of recurrent lesions | ||||
Single | 89 (60.5) | 66 (68.8) | 23 (45.1) | 0.005 |
Multiple | 58 (39.5) | 30 (31.3) | 28 (54.9) | |
Recurrent site | ||||
Local | 24 (16.3) | 20 (20.8) | 4 (7.8) | 0.128 |
Regional | 107 (72.8) | 66 (68.8) | 41 (80.4) | |
Loco-regional | 16 (10.9) | 10 (10.4) | 6 (11.8) | |
Stage at recurrence | ||||
II | 131 (89.1) | 86 (89.6) | 45 (88.2) | 0.549 |
III | 16 (12.4) | 10 (11.2) | 6 (15.0) | |
Techniques for salvage RT | ||||
3D-CRT | 116 (78.9) | 85 (88.5) | 31 (60.8) | 0.001 |
IMRT | 31 (21.1) | 11 (11.5) | 20 (39.2) | |
RT dose (Gy) | 60.0 (30.0-70.0) | 60 (30.0-63.5) | 66.0 (38.0-70.0) | 0.001 |
BED10 (Gy10) | 78.0 (37.5-84.0) | 78.0 (37.5-82.6) | 79.2 (45.6-84.0) | 0.001 |
Variable | No. | Overall survival |
Progression-free survival |
||||||
---|---|---|---|---|---|---|---|---|---|
Univariate |
Multivariate |
Univariate |
Multivariate |
||||||
HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | HR (95% CI) | p-value | ||
Age (yr) | |||||||||
< 65 | 70 | 1 | 0.256 | - | - | 1 | 0.878 | - | - |
≥ 65 | 77 | 0.813 (0.570-1.162) | - | 1.027 (0.726-1.454) | - | ||||
Performance status | |||||||||
ECOG 0-1 | 127 | 1 | 0.119 | 1 | 0.258 | 1 | 0.656 | - | - |
ECOG 2-3 | 20 | 1.228 (0.949-1.589) | 1.356 (0.800-2.299) | 1.060 (0.820-1.369) | - | ||||
Initial T category | |||||||||
T0-1 | 48 | 1 | 0.019 | 1 | 0.253 | 1 | 0.122 | 1 | 0.542 |
T2-4 | 99 | 1.609 (1.081-2.394) | 1.256 (0.850-1.857) | 1.351 (0.923-1.978) | 1.135 (0.756-1.703) | ||||
Initial N category | |||||||||
N0-1 | 41 | 1 | 0.104 | 1 | - | 1 | 0.092 | 1 | 0.319 |
N2-3 | 106 | 1.175 (0.967-1.428) | 1.253 (0.833-1.885) | 1.178 (0.974-1.425) | 1.225 (0.822-1.827) | ||||
Initial treatment | |||||||||
Surgery alone | 90 | 1 | 0.495 | - | - | 1 | 0.483 | - | - |
Surgery+CTx | 57 | 0.879 (0.608-1.272) | - | 1.137 (0.795-1.625) | - | ||||
No. of lesions | |||||||||
Single | 89 | 1 | 0.212 | - | - | 1 | 0.454 | - | - |
Multiple | 58 | 1.259 (0.877-1.807) | - | 1.145 (0.803-1.634) | - | ||||
Disease-free interval (mo) | |||||||||
< 24 | 114 | 1 | 0.139 | 1 | 0.495 | 1 | 0.037 | 1 | 0.097 |
≥ 24 | 33 | 0.717 (0.461-1.114) | 0.849 (0.531-1.358) | 0.628 (0.405-0.973) | 0.679 (0.430-1.072) | ||||
Treatment | |||||||||
RT alone | 96 | 1 | 0.389 | - | - | 1 | 0.155 | 1 | 0.127 |
CCRT | 51 | 0.845 (0.577-1.239) | - | 0.763 (0.526-1.108) | 0.746 (0.512-1.087) | ||||
BED10 (Gy10) | |||||||||
< 78 | 56 | 1 | 0.035 | 1 | 0.126 | 1 | 0.129 | 1 | 0.221 |
≥ 78 | 91 | 0.678 (0.472-0.974) | 0.744 (0.509-1.087) | 0.759 (0.532-1.084) | 0.795 (0.550-1.148) | ||||
RT technique | |||||||||
3D-CRT | 1 | 0.324 | - | - | 0.999 (0.803-1.242) | 0.990 | - | - | |
IMRT | 0.890 (0.707-1.122) | - | - | ||||||
Treatment year (continuous) | 0.998 (0.970-1.208) | 0.916 | - | - | 0.998 (0.961-1.015) | 0.367 | - | - |
Toxicity | Grade |
|||
---|---|---|---|---|
1 | 2 | 3 | 4 | |
Hematologic toxicity | ||||
Febrile neutropenia | - | - | 1 (0.7) | - |
Anemia | 7 (4.8) | 13 (8.8) | 2 (1.4) | - |
Thrombocytopenia | 4 (2.7) | 5 (3.4) | - | - |
Hyponatremia | 12 (8.2) | - | 2 (1.4) | - |
Creatinine elevation | 1 (0.7) | 1 (0.7) | - | - |
Acute non-hematologic toxicity | ||||
Esophagitis | 55 (37.4) | 46 (31.3) | - | - |
Nausea and vomiting | 36 (24.5) | 5 (3.4) | - | - |
Stomatitis | 7 (4.8) | 4 (2.7) | 1 (0.7) | - |
Dermatitis | 12 (8.2) | 3 (2.0) | - | - |
Pneumonia | - | 1 (0.7) | 4 (2.7) | - |
Late non-hematologic toxicity | ||||
Esophageal stricture | 1 (0.7) | 9 (6.1) | 1 (0.7) | - |
Esophageal perforation | - | - | - | 1 (0.7) |
Esophageal fistula | - | - | 1 (0.7) | 3 (2.0) |
Radiation pneumonitis | 1 (0.7) | 3 (2.0) | - | - |
Tracheal stenosis | - | - | 1 (0.7) | - |
Grade 3 or higher toxicities | p-value | |
---|---|---|
RT alone | 6/96 (6.3) | 0.023 |
CCRT | 10/51 (19.6) | |
3D-CRT | 12/104 (11.5) | 0.685 |
IMRT | 4/27 (14.8) | |
BED10 < 78 Gy | 8/56 (14.3) | 0.414 |
BED10 ≥ 78 Gy | 8/91 (8.8) | |
RT alone, BED10 < 78 Gy | 3/40 (7.5) | 0.042 |
RT alone, BED10 ≥ 78 Gy | 3/56 (5.4) | |
CCRT, BED10 < 78 Gy | 5/16 (31.3) | |
CCRT, BED10 ≥ 78 Gy | 5/35 (14.3) |
Variable | Overall survival |
Progression-free survival |
||
---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | |
ECOG performance status (2-3 vs. 0-1) | 1.398 (0.823-2.374) | 0.215 | 1.028 (0.607-1.741) | 0.919 |
Treatment (RT vs. CCRT) | 1.121 (0.760-1.653) | 0.565 | 1.298 (0.885-1.902) | 0.182 |
Risk group (high vs. low) | 1.575 (1.074-2.309) | 0.020 | 1.469 (1.013-2.131) | 0.043 |
BED10 (< 78 Gy vs. ≥ 78 Gy) | 1.321 (0.909-1.919) | 0.144 | 1.257 (0.872-1.811) | 0.220 |
Values are presented as median (range) or number (%). 3D-CRT, 3-dimensional conformal RT; BED10, median biological effective dose with α/β=10; CCRT, concurrent chemoradiotherapy; ECOG, Eastern Cooperative Oncology Group; IMRT, intensity-modulated radiotherapy; RT, radiotherapy.
3D-CRT, 3-dimensional conformal RT; BED10, biologically effective dose with a/b ratio of 10 Gy; CCRT, concurrent chemoradiotherapy; CI, confidence interval; CTx, chemotherapy; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio; IMRT, intensity-modulated radiotherapy; RT, radiotherapy.
Values are presented as number (%).
Values are presented as number (%). 3D-CRT, 3-dimensional conformal radiotherapy; BED10, biologically effective dose with a/b ratio of 10 Gy; CCRT, concurrent chemoradiotherapy; IMRT, intensity-modulated radiotherapy; RT, radiotherapy.
BED10, biologically effective dose with a/b ratio of 10 Gy; CCRT, concurrent chemoradiotherapy; CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio; RT, radiotherapy.