What dose of radiation do you use for neoadjuvant chemoradiation in esophageal cancer?
The CROSS trial showed a survival benefit with 4140 cGy and concurrent carbo/taxol, but I was always trained to treat to 5040 cGy. Is anyone de-escalating the RT dose?
Answer from: Radiation Oncologist at Academic Institution
The CROSS trial does not exist in a vacuum. We have a long history of esophageal trials by the RTOG and other cooperative groups that consistently used chemoradiation to 5040 cGy, and this remains the standard of care in the U.S. That said, if I have to treat a very long tumor, resulting in lung m...
Comments
Radiation Oncologist at Tri-Cities Cancer Center Any updates on this question? I have typically use...
Radiation Oncologist at GenesisCare USA Hi Sue, 45 Gy is very reasonable and tolerable. Th...
Radiation Oncologist at Tri-Cities Cancer Center The question of surgery versus no surgery is alway...
Radiation Oncologist at GenesisCare USA I agree. It’s a concern if the preoperative ...
Radiation Oncologist at Gulf International Cancer Center All reasonable recommendations.
Answer from: Radiation Oncologist at Academic Institution
I agree with @Harvey J. Mamon's answer and 50.4 Gy is the standard preoperative dose at our center. I also agree with the other comments that this dose, since it is identical to the standard definitive dose for esophageal cancer, allows us to have delivered the recommended dose of RT to patients who...
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Radiation Oncologist at Carolina Regional Cancer Center Do you routinely take elective nodal volumes to 50...
Radiation Oncologist at Memorial Sloan Kettering Cancer Center Yes, I take nodal volumes to 50.4 Gy as well. I on...
Radiation Oncologist at Radiant Oncology @Harvey J. Mamon @Chirag S. Shah
Is there any evi...
Answer from: Radiation Oncologist at Community Practice
If normal tissue constraints can be met, I always try to achieve a dose goal of 50.4 Gy. That way, if for some reason, the patient is unable to undergo the planned surgical resection, he will have received a definitive dose of RT. I usually will perform a cone down at 45 Gy to help limit dose to the...
Answer from: Radiation Oncologist at Community Practice
I think its crucial to note the role of biology here. The CROSS trial was overwhelmingly adenocarcinomas, whereas the historical trials have been majority squamous cell carcinoma. As such, i think a simple rule of thumb is to look at the chemo. the med/oncs will usually based choice of chemo on h...
Any updates on this question? I have typically use...
Hi Sue, 45 Gy is very reasonable and tolerable. Th...
The question of surgery versus no surgery is alway...
I agree. It’s a concern if the preoperative ...
All reasonable recommendations.