Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients

2004 ◽  
Vol 60 (5) ◽  
pp. 1484-1493 ◽  
Author(s):  
Zhongxing Liao ◽  
Zhen Zhang ◽  
Jing Jin ◽  
Jaffer A. Ajani ◽  
Stephen G. Swisher ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Clinical Stage ◽  
Stage Ii ◽  
Locoregional Control

scholarly journals 18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy

2021 ◽  
Vol 20 ◽  
pp. 153303382110246
Author(s):  
Seokmo Lee ◽  
Yunseon Choi ◽  
Geumju Park ◽  
Sunmi Jo ◽  
Sun Seong Lee ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Concurrent Chemoradiotherapy ◽  
Curative Intent ◽  
Squamous Cell Esophageal Cancer ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

scholarly journals Long-Term Survival in Nonsurgical Esophageal Cancer Patients Who Received Consolidation Chemotherapy Compared With Patients Who Received Concurrent Chemoradiotherapy Alone: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Xiaojie Xia ◽  
Zeyuan Liu ◽  
Qin Qin ◽  
Xiaoke Di ◽  
Zhaoyue Zhang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Meta Analysis ◽  
Objective Response ◽  
Progression Free Survival ◽  
Cochrane Library ◽  
Consolidation Chemotherapy ◽  
Term Survival ◽  
Treatment Toxicity

BackgroundConcurrent chemoradiotherapy (CCRT) is the standard treatment for nonsurgical esophageal cancer (EC). However, esophageal cancer patients receiving CCRT alone are still unsatisfactory in terms of local control and overall survival (OS) benefit. Clinicians generally add consolidation chemotherapy (CCT) after CCRT. It remains controversial whether CCT following CCRT is beneficial for esophageal cancer. We, therefore, undertook a meta-analysis to assess the need for CCT in inoperable esophageal cancer.Materials and MethodsWe combed PubMed, Embase, Cochrane Library, Web of Science, and CNKI for relevant published articles up to July 2020 that compared CCRT plus CCT to CCRT alone for patients with nonsurgical EC. Our primary endpoint was OS and progression-free survival (PFS), and the secondary endpoint was treatment toxicity. We analyzed the hazard ratio (HR) to estimate the time-to-event data and the odds ratio (OR) to compare the treatment-related effect. To assess heterogeneity, we performed the I2 test and examined publication bias using funnel plots analysis.ResultsThe 11 retrospective studies involved 2008 patients. Of these 2008 patients, 1018 received CCRT plus CCT, and 990 received CCRT. Compared to CCRT alone, CCT after CCRT did not improve disease control rate (DCR) (OR 1.66; 95% CI 0.53–5.15, p=0.384) and objective response rate (ORR) (OR 1.44; 95% CI 0.62–3.35, p=0.393). However, OS (HR 0.72; 95% CI 0.59–0.86, p < 0.001) and PFS (HR 0.61; 95% CI 0.44–0.84, p=0.003) did increase. Our results show that CCT plus CCRT had a clear survival advantage over CCRT alone. The risk of treatment toxicity did not increase for EC patients who received CCT.ConclusionCCT after CCRT significantly increases OS and PFS in patients with nonsurgical EC and could provide them remarkable survival benefits. The results provide an evidence-based framework for the use of CCT after CCRT.

scholarly journals Clinical Factors to Predict the Response to Concurrent Chemoradiotherapy and Survival in Esophageal Cancer Patients

Gut and Liver ◽  
2020 ◽  
Vol 14 (4) ◽  
pp. 450-458
Author(s):  
Su Youn Nam ◽  
Seong Woo Jeon ◽  
Sang Jik Lee ◽  
Yong Hwan Kwon ◽  
Hyun Seok Lee ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Concurrent Chemoradiotherapy ◽  
Clinical Factors

scholarly journals Tumor Size as a Critical Prognostic Factor in T1-2 Stage Esophageal Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Zilong Wu ◽  
Bentong Yu
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factor ◽  
Cancer Patients ◽  
Tumor Size ◽  
Cox Model ◽  
Clinical Stage ◽  
Discriminative Ability ◽  
Tnm System ◽  
Model Based ◽  
T Stage

Background. Tumor size has been measured in esophageal cancer for decades, but the role of tumor size in relation to T stage in the prediction of survival is still underappreciated. Thus, the present study is aimed at investigating the influence of T stage on the predictive value of tumor size in clinical stage I–IV esophageal cancer patients. Materials and Methods. Data were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) cancer registry program. Cox proportional hazards regression was utilized to identify the independent prognostic ability of the factor. Kaplan-Meier analysis was used to estimate the distribution of survival outcome. Harrell’s concordance index (c-index) was used to quantify the predictive ability of the prognostic model and prognostic factor. Results. According to the T stage, subgroup analysis showed that tumor size was not an independent risk factor in T3 and T4 stage esophageal cancer patients. Furthermore, the predictive power of tumor size was negatively impacted by the increase in T stage. Furthermore, the discriminative ability of the Cox model based on the tumor-node-metastasis (TNM) system with tumor size outperformed the model based on the TNM system only. Conclusion. The current study identified tumor size as a critical clinical prognostic signature for esophageal cancer with considerable discriminatory ability and prognostic value. Therefore, tumor size should be included in the American Joint Committee on Cancer (AJCC) TNM staging of T1-2 esophagus cancer patients.

PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 128-129
Author(s):  
Hiroshi Okamoto ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Stage Ii ◽  
Definitive Chemoradiotherapy

Abstract Background Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC. Methods We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015. Results Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively. Conclusion DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation. Disclosure All authors have declared no conflicts of interest.

Retrospective analysis of neoadjuvant chemoradiotherapy for esophageal cancer: The Knight Cancer Institute experience.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 126-126
Author(s):  
Faisal A Siddiqui ◽  
James P. Dolan ◽  
John G. Hunter ◽  
Miriam A. Douthit ◽  
Lisa M. Bloker ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Complete Remission ◽  
Early Stage ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Stage Ii ◽  
R0 Resection ◽  
Trimodality Therapy ◽  
Initial Staging

126 Background: Neoadjuvant chemoradiotherapy (NAT) followed by esophagectomy has been established as standard of care for early stage (II – III), resectable esophageal cancer (EC). Patients (pts) treated with NAT are more likely to be downstaged and have a complete (R0) resection. Additionally, pts with aggressive disease are more likely to progress during NAT and, consequently, avoid unnecessary surgery. The aim of the current report was to analyze the outcomes of trimodality therapy at the Knight Cancer Institute. Methods: A retrospective study of 124 pts who underwent NAT followed by esophagectomy for EC from 1999-2010 at our institution was performed. All pts were initially staged by imaging (EUS, CT and/or PET imaging) prior to commencing treatment. After esophagectomy, pathological staging was compared to initial staging to determine the effect of NAT. Results: There were 25 women and 99 men. Initial staging is shown in the table below. Patients received cisplatin, oxaliplatin or carboplatin with 5-FU plus concurrent radiotherapy (RT). RT total dose of 45 Gy to the tumor and regional nodes was given in 1.8 Gy daily fractions, followed by a boost to the tumor for final dose 50.4-54 Gy. 27 (21.8%) of the pts had a pathologic complete response. Additionally, 54 (43.6%) pts were downstaged by chemoradiation. Of the pts that had complete remission or were downstaged, pre-treatment clinical stage was Stage II (22 pts), Stage III (55 pts), and Stage IVa (4 pts). Conclusions: NAT was effective in complete remission or downstaging of two-thirds (81) pts, including 4 pts that were initially unresectable (Stage IVa) and successfully underwent subsequent esophagectomy. As has been shown previously, NAT is effective for downstaging prior to esophagectomy making it more likely that pts will undergo R0 resection. This study also demonstrated that some pts with clinically unresectable tumors could undergo successful esophagectomy after NAT. [Table: see text]

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