Definitive or neoadjuvant chemoradiotherapy for squamous cell oesophageal cancer?

Abstract Background: Surgery is the gold standard treatment for local advanced disease, while definitive concurrent chemoradiotherapy (DCRT) is recommended for those who are medically unable to tolerate major surgery or medically fit patients who decline surgery. The primary aim of this trial is to compare the outcomes in Chinese oesophageal squamous cell cancer patients with locally advanced resectable disease who have received either surgery or DCRT. Methods/design: One hundred ninety-six patients with T1bN+M0 or T2-4aN0-2M0 oesophageal squamous cell cancer will be randomized to the DCRT group or the surgery group. In the DCRT group, patients will be given intensity modulation radiation therapy (IMRT) with 50 Gy/25 fractions and basic chemotherapy with 5-fluorouracil (5-FU) regimens. In the surgery group, patients will receive neoadjuvant chemoradiotherapy (NCRT) and standard oesophagectomy. Five years of follow-up will be scheduled for patients. The primary endpoints are 2-year/5-year overall survival; the secondary endpoints are 2-year/5-year progression-free survival, treatment-related adverse events and the patients’ quality of life. The main evaluation methods include oesophagoscopy, endoscopic ultrasonography and biopsy, oesophageal barium meal, CT, PET-CT, blood tests, and questionnaires. Discussion: The preponderant oesophageal cancer pathology type is dramatically different in western Caucasian and Asian oesophageal cancer patients: Caucasian patients present with 80% adenocarcinomas, and Asians patients present with 95% squamous cell carcinomas. This phenomenon needs more in-depth studies to elucidate the differences in these populations. Based on the results of this study, we will show whether DCRT will benefit patients more than oesophagectomy. It will contribute more evidence to the management of oesophageal squamous cell cancer.

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272 10-YEAR FOLLOW-UP OF A RANDOMISED CONTROLLED TRIAL COMPARING NEOADJUVANT CHEMORADIOTHERAPY PLUS SURGERY VERSUS SURGERY ALONE FOR OESOPHAGEAL CANCER (CROSS)

Diseases of the Esophagus ◽

10.1093/dote/doaa087.56 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

B Eyck ◽

J Lanschot ◽

M Hulshof ◽

B Wilk ◽

J Shapiro ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Oesophageal Cancer ◽

Squamous Cell ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Oesophagogastric Junction ◽

Randomised Controlled

Abstract Neoadjuvant chemoradiotherapy according to the Dutch randomised controlled ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) has become standard of care for patients with cancer of the oesophagus or oesophagogastric junction. The aim of this study was to provide more insight into the ultra-long-term impact of CROSS neoadjuvant chemoradiotherapy on survival and disease recurrence for patients with oesophageal cancer. Methods Patients with locally advanced resectable squamous cell carcinoma or adenocarcinoma of the oesophagus or oesophagogastric junction were randomised between neoadjuvant chemoradiotherapy (five weekly cycles of intravenous carboplatin [AUC 2 mg/mL per min] and intravenous paclitaxel [50 mg/m2 of body-surface area]) with concurrent 41.4 Gy radiotherapy given in 23 fractions of 1.8 Gy, 5 days per week) plus surgery (nCRT arm) versus surgery alone (surgery arm). Primary endpoint was overall survival, defined from date of randomisation to date of all-cause death or to last day of follow-up. Secondary endpoints were cause-specific mortality and conditional survival. Analysis was by intention-to-treat. Results From 2004 through 2008, 178 patients were randomized to the nCRT arm and 188 to the surgery arm. Median follow-up for surviving patients was 146.6 months (IQR 133.5–157.2). Ten-year overall survival was 38% in the nCRT arm and 25% in the surgery arm (HR 0.68 [95%CI 0.53–0.87]). For patients with squamous cell carcinoma ten-year overall survival was 46% in the nCRT arm compared to 23% in the surgery arm. For patients with adenocarcinoma ten-year overall survival was 36% in the nCRT arm and 26% in the surgery arm. In the nCRT arm, ten-year oesophageal cancer-specific mortality was 47%. Conclusion Survival benefit of patients with locally advanced resectable squamous cell carcinoma or adenocarcinoma of the oesophagus or oesophagogastric junction receiving neoadjuvant chemoradiotherapy persists for at least 10 years compared to patients undergoing surgery alone.

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Chemoradiation versus Oesophagectomy for Locally Advanced Oesophageal Cancer in Chinese patients: study protocol for a randomized controlled trial

10.21203/rs.2.172/v2 ◽

2019 ◽

Author(s):

Ruinuo Jia ◽

Weijiao Yin ◽

Shuoguo Li ◽

Ruonan Li ◽

Junqiang Yang ◽

...

Keyword(s):

Cancer Patients ◽

Oesophageal Cancer ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Chinese Patients ◽

Cancer Trial ◽

Surgery Group

Abstract Background: Surgery is the gold standard treatment for local advanced disease, while definitive concurrent chemoradiotherapy (DCRT) is recommended for those who are medically unable to tolerate major surgery or medically fit patients who decline surgery. The primary aim of this trial is to compare the outcomes in Chinese oesophageal squamous cell cancer patients with locally advanced resectable disease who have received either surgery or DCRT. Methods/design: One hundred ninety-six patients with T1bN+M0 or T2-4aN0-2M0 oesophageal squamous cell cancer will be randomized to the DCRT group or the surgery group. In the DCRT group, patients will be given intensity modulation radiation therapy (IMRT) with 50 Gy/25 fractions and basic chemotherapy with 5-fluorouracil (5-FU) regimens. In the surgery group, patients will receive neoadjuvant chemoradiotherapy (NCRT) and standard oesophagectomy. Five years of follow-up will be scheduled for patients. The primary endpoints are 2-year/5-year overall survival; the secondary endpoints are 2-year/5-year progression-free survival, treatment-related adverse events and the patients’ quality of life. The main evaluation methods include oesophagoscopy, endoscopic ultrasonography and biopsy, oesophageal barium meal, CT, PET-CT, blood tests, and questionnaires. Discussion: The preponderant oesophageal cancer pathology type is dramatically different in western Caucasian and Asian oesophageal cancer patients: Caucasian patients present with 80% adenocarcinomas, and Asians patients present with 95% squamous cell carcinomas. This phenomenon needs more in-depth studies to elucidate the differences in these populations. Based on the results of this study, we will show whether DCRT will benefit patients more than oesophagectomy. It will contribute more evidence to the management of oesophageal squamous cell cancer. Trial registration: ClinicalTrials.gov identifier NCT02972372; registered on November 26, 2016；the URL of the trial registry record: https://clinicaltrials.gov/ct2/show/NCT02972372?term=shegan+gao&rank=1

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Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020633 ◽

2021 ◽

Vol 50 (7) ◽

pp. 536-547

Author(s):

Caryn Wujanto ◽

Jeremy Tey ◽

Balamurugan Vellayappan ◽

Jimmy So ◽

Wei Peng Yong ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Oesophageal Cancer ◽

Squamous Cell ◽

Multivariable Analysis ◽

Neoadjuvant Chemoradiotherapy ◽

Disease Free Survival ◽

Feeding Tube ◽

Definitive Chemoradiotherapy ◽

Tube Versus

Introduction: We report outcomes of patients with oesophageal cancer treated with neoadjuvant chemoradiotherapy (NACRT) plus surgery or definitive chemoradiotherapy (chemoRT) at our institution. Methods: We retrospectively reviewed patients who underwent chemoRT from 2005 to 2017. The primary outcome was overall survival (OS). Secondary outcomes were disease-free survival (DFS) and toxicities. Results: We identified 96 patients with median age of 64 years and squamous cell carcinoma in 82.3%. Twenty-nine patients (30.2%) received NACRT plus surgery, 67 patients (69.8%) received definitive chemoRT. Median follow-up was 13.5 months. The 3/5-year OS were 26.4%/13.4%, and 59.6%/51.6% in the definitive chemoRT and NACRT plus surgery groups, respectively. The 3/5-year DFS were 19.3%/12.3%, and 55.7%/37.2% in the definitive chemoRT and NACRT plus surgery groups, respectively. NACRT plus surgery significantly improved OS (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.22–0.72, P<0.01) and DFS (subhazard ratio [SHR] 5.21, 95 CI 1.20–22.7, P=0.03). Multivariable analysis for OS in the definitive chemoRT group indicated stage (1–2 vs 3–4a; HR 2.17, 95% CI 1.15–4.11, P=0.02) and feeding tube (no tube versus tube; HR 1.85, 95% CI 1.00–3.43, P=0.05) as significantly associated with OS. The cumulative incidence of local recurrence was significantly higher in the definitive chemoRT group (SHR 5.21, 95 CI 1.2022.7, P=0.03). Nineteen patients (65.5%) had postoperative complications. Conclusion: NACRT plus surgery improved OS and DFS. However, in view of treatment-related complications, careful selection of patients is warranted. With the predominant histology of our cohort being squamous cell carcinoma (SCC), our results may be more re levant for those with SCC. Keywords: Neoadjuvant chemoradiotherapy, oesophageal cancer, surgery

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18F-Deoxyglucose PET for the staging of oesophageal cancer

Nuklearmedizin ◽

10.1055/s-0038-1625303 ◽

2003 ◽

Vol 42 (03) ◽

pp. 90-93 ◽

Cited By ~ 9

Author(s):

N. Döbert ◽

O. Rieker ◽

W. Kneist ◽

St. Mose ◽

A. Teising ◽

...

Keyword(s):

Oesophageal Cancer ◽

Squamous Cell ◽

Distal Part ◽

Standard Uptake Value ◽

Squamous Cell Carcinomas ◽

Tumour Grading ◽

Positron Emission ◽

Group A ◽

The Mean ◽

Drop Outs

SummaryAim: Evaluation of the influence of histopathologic sub-types and grading of primaries of oesophageal cancer, relative to their size and location, on the uptake of 18F-deoxyglucose (FDG) as measured by positron emission tomography (PET). Methods: 50 consecutive patients were evaluated. There were four drop-outs due to previous surgical and/or chemotherapeutical treatments and thus in 46 patients (28 squamous cell carcinomas and 18 adenocarcinomas) a pretherapeutic PET evalution of the primary including a standard uptake value (SUV) was obtained. In 42 cases data on tumour grading were available also. Results: Squamous cell carcinomas (SCC) were in 7/13/8 cases located in the proximal, medial and distal part of the oesophagus, respectively the grading was Gx in 3, G 2 in 12, G2-3 in 7, and G3 in 6 cases. The SUVmax showed a mean of 6.5 ± 2.8 (range 1.7-13.5). Adenocarcinomas (ACA) were located in the medial oesophagus in two cases and otherwise in its distal parts. Grading was Gx in one, G2 in 4, G2-3 in 3, G3 in 3, G3-4 in 3, and G4 in one case. The mean SUVmax was 5.2 ± 3.2 (range 1-13.6) and this was not significantly different from the SCC. Concerning the tumour grading there was a slight, statistically not relevant trend towards higher SUVmax in more dedifferentiated cancer. Discussion: SCC and ACA of the oesophagus show no relevant differences in the FDG-uptake. While there was a significant variability of tumour uptake in the overall study group, a correlation of SUV and tumour grading was not found.

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