Complete Response After Neoadjuvant Radio-Chemotherapy for Squamous Cell Cancer of the Thoracic Esophagus: Prognostic Significance and Clinical Implications

Treatment results of combined radiotherapy and polychemotherapy in a group of 38 patients with advanced squamous cell of the head and neck cancer are presented. The radio-chemotherapy schedule included 60Co irradiation with 20 Gy in 10 fractions over two weeks followed by multidrug chemotherapy with vincristin, bleomycin, methotrexate and leucovorin. Three series of radio-chemotherapy were given. In 14 patients the total dose of irradiation was increased to 70-105 Gy. The probabilities of overall and symptom-free survival at 2 years were 32% and 20%, respectively. Treatment results correlated with stage of the disease. Patients who received higher doses of radiation seemed to have better chances of symptom-free survival.

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Cetuximab, paclitaxel, carboplatin and radiation for esophageal and gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.4029 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 4029-4029 ◽

Cited By ~ 9

Author(s):

M. Suntharalingam ◽

T. Dipetrillo ◽

P. Akerman ◽

H. Wanebo ◽

B. Daly ◽

...

Keyword(s):

Gastric Cancer ◽

Esophageal Cancer ◽

Head And Neck Cancer ◽

Head And Neck ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Locally Advanced ◽

Complete Response ◽

Grade 3

4029 Background: Cetuximab is an IgG1, chimerized, monoclonal antibody that binds specifically to the epidermal growth factor receptor. Cetuximab improves survival when combined with radiation for patients with locally advanced head and neck cancer. We evaluated the safety and efficacy of the addition of cetuximab to concurrent chemoradiation for patients with esophageal and gastric cancer. Methods: Patients with adenocarcinoma or squamous cell cancer of the esophagus or stomach without distant organ metastases were eligible. Patients with locally advanced disease from mediastinal, celiac, portal and gastric lymphadenopathy were eligible. Surgical resection was not required. Clinical complete response was defined as no tumor on postreatment endoscopic biopsy. Patients received cetuximab, 400mg/m2 week #1 then 250 mg/m2/week for 5 weeks, paclitaxel, 50 mg/m2/week, and carboplatin, AUC =2 weekly for 6 weeks, with concurrent 50.4 Gy radiation. Results: Thirty-seven patients have been entered. The median age was 61 (range of 30–87). Thirty-four have esophageal cancer and 3 have gastric cancer. Of the patients with esophageal cancer, twenty-five have adenocarcinoma and nine have squamous cell cancer. Thus far, 30 patients have completed treatment and are evaluable for toxicity. There have been no grade 4 non-hematologic toxicities and 1 pt had grade 4 neutropenia (3%). Six patients (20%) had grade 3 esophagitis. Other grade 3 toxicities included dehydration (n=5), rash (n=9), and paclitaxel/cetuximab hypersensitivity reactions (n=2). Eighteen of 27 patients (67%) have had clinical complete response. Seven pts out of 16 (43%) who have gone to surgery have had a pathologic CR. Conclusions: Cetuximab can be safely administered with chemoradiation for patients with esophageal cancer. Consistent with the data in head and neck cancer, cetuximab increases cutaneous toxicity but does not increase mucositis/esophagitis when combined with chemoradiation. Further evaluation is ongoing. [Table: see text]

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A prospective study investigating the impact of definitive chemoradiation in locoregionally advanced squamous cell carcinoma of the skin.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.8538 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 8538-8538 ◽

Cited By ~ 2

Author(s):

Michelle K. Nottage ◽

Alessandra Bastian Francesconi ◽

Kathleen Emilie Mary Houston ◽

Charles Lin ◽

Lizbeth M. Kenny ◽

...

Keyword(s):

Squamous Cell ◽

Response Rate ◽

Complete Response Rate ◽

Squamous Cell Cancer ◽

Performance Status ◽

Cell Cancer ◽

Prospective Trial ◽

Complete Response ◽

Platinum Based Chemotherapy ◽

The Impact

8538 Background: Our state, Queensland, Australia, has the highest rate of cutaneous squamous cell cancer (SCC) in the world. Spread to regional lymph nodes or more distant sites occurs in 5-10%. A proportion of patients can not undergo surgical resection but complete response rates with radiotherapy alone are low. This led to the hypothesis that combined chemoradiation (CRT) may be of benefit. We decided to document the outcomes of concurrent chemoradiation by means of a prospective trial. Methods: This was a single arm, phase II study with planned sample size 30 patients. The primary endpoint was complete response rate (CRR), estimate 60%. Patients with locally/regionally advanced (non-metastatic) cutaneous SCC deemed unresectable or unsuitable for surgery by consensus of the multidisciplinary Head and Neck Cancer Clinic, with measurable disease, aged over 18, performance status 0-2, received definitive radiotherapy (XRT) (70Gy in 35#) and concurrent weekly platinum based chemotherapy (CT) (cisplatin 40mg/m2 or carboplatin AUC 2). Results: 14 patients were enrolled (Feb 2008-June 2011), median age 66 (48-84), 64% ECOG PS 0, 64% stage IV, 57% nodal disease only. Cisplatin/carboplatin was administered in 64%/36% respectively. 42% received all planned CT while 58% had 1 or 2 weeks omitted. 2 patients had dose reductions. XRT was completed as planned in 93%. The CRR was 57% (8/14) at analysis in December 2011 (median follow-up 13.5m). 2 further patients with partial response (PR) achieved CR after undergoing salvage surgery. Six (43%) patients had a PR; 4(29%) did not receive surgery and later progressed. Median overall survival was not reached, with 3 year survival 54%. The most frequent toxicities were dermatitis, mucositis, thrombocytopenia, nausea, anaemia, dysphagia. 28% had grade 3/4 toxicity, mainly cytopenias, infection, dehydration and nausea. Conclusions: This is the only prospective series of CRT for cutaneous squamous cell cancer. A high complete response rate was documented in patients with loco-regionally advanced disease and multiple co-morbidities, with acceptable toxicity, making this a reasonable alternative for patients unable to undergo surgery.

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