CONCLUSION


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In conclusion, the available data reveal that LC after DCRT for EC remains a problem and that most local failures occur within the primary tumor. This indicates that the standard RT dose (50.4 Gy in 28 fractions) may be inadequate to achieve a high probability for LC for some subgroup patients. It is warranted to explore potential ways of improving LC, including IMRT and VMAT techniques, radiation dose escalation, and the use of more effective dose fractionation strategies. Some studies have found that the use of a higher dose and late course of accelerated hyperfraction radiation may lead to better LC and survival for EC patients undergoing CRT. Nevertheless, there is no evidence from Phase III randomized trials to support the additional benefit of dose-escalated RT. Although there is a potential for better tumor LC, there is also an associated higher incidence of toxicity. Therefore, the higher radiation dose should be used with caution on an individual basis in patients with EC.

It has been reported that EC probably has variable sensitivities to CRT. Therefore further studies will be required to: 1) identify the factors involved in EC sensitivity to radiation; 2) determine the causes of recurrence and non-control from molecular biology perspectives; and 3) individually determine the target region of RT, fractionated dose, and total dose to increase both LC and survival rates and decrease the rates of metastasis in patients with EC.

Acknowledgment

This study was funded by the Natural Science Foundation of China (NSFC 81672995) and The Key Research and Development Program of Shandong Province (2016GSF201133).

Disclosure

The authors report no conflicts of interest in this work.


Yijun Luo,1,* Qingfeng Mao,2,3,* Xiaoli Wang,1 Jinming Yu,3 Minghuan Li3

1Department of Oncology, The People’s Hospital of Jiangxi, Nanchang, 2School of Medical and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, 3Department of Radiation Oncology and Radiology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China

*These authors contributed equally to this work 


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Source: Cancer Management and Research.
Originally published December 29, 2017.