Procedures
dysphagia, tumor, upper gastrointestinal contrast, bone pain
DYSPHAGIA, DISEASE PROGRESSION, TUMOR, RECURRENCE, MALNUTRITION, PRIMARY TUMOR
The enrolled patients were recommended to undergo nutritional interventions, including feeding tube or gastrostomy feeding before treatment if assessment of their nutritional status indicated a risk of malnutrition. The baseline imaging included endoscopy with biopsy, endoscopic ultrasonography, barium esophagography, chest and abdominal computed tomography (CT), cervical ultrasonography and CT, and, if available, positron-emission tomography (PET) CT. Comorbid conditions of enrolled participants were evaluated with the CCI, which has been shown to be an independent risk factor associated with surgical mortality as well as long-term survival.In the CRTCT group, concurrent S-1 was administered orally twice daily on RT days (total daily dosage, 40, 50, or 60 mg/mRadiation was delivered using IMRT or volumetric-modulated arc therapy. The gross tumor volume (GTV) was defined as visible primary tumor delineated by physicians using all possible resources (barium esophagram, CT, esophagogastroduodenoscopy, endoscopic ultrasonography, and if available, PET CT), metastatic regional nodes. The clinical target volume (CTV) consisted of the primary tumor plus a 0.6- to 0.8-cm circumferential margin, a 3-cm craniocaudal margin and metastatic regional nodes, plus a 0.5-cm margin in all directions and covering the corresponding lymphatic drainage region. The PTV is defined as CTV plus a uniform 0.5-cm margin. For SIB-RT, the PGTV was administered at 59.92 Gy (EQD2, 60.62Gy) and the PTV was administered at 50.4 Gy, in 28 fractions each.All patients will be followed-up for at least 5 years after completion of the protocol, every 3 months for the first 2 years, every 6 months for years 3 to 5, and once a year after 5 years. Every follow-up should include history-taking; bloodwork (basic metabolic panel); contrast-enhanced CT of the neck, thorax, and abdomen; ultrasonography of the neck and abdomen; upper gastrointestinal contrast; endoscopy (in patients experiencing recurrence or progression of dysphagia); bone scan (in patients experiencing bone pain or with elevated alkaline phosphatase levels); magnetic resonance imaging of the brain (in patients experiencing any symptoms related to central nervous system); and documentation of patients’ status of survival, disease progression, subsequent treatment, nutrition, quality of life, and late toxic effects.