scholarly journals Skeletal muscle mass correlates with increased toxicity during neoadjuvant radiochemotherapy in locally advanced esophageal cancer: A SAKK 75/08 substudy

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Cédric M. Panje ◽  
◽  
Laura Höng ◽  
Stefanie Hayoz ◽  
Vickie E. Baracos ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Skeletal Muscle Mass ◽  
Postoperative Morbidity ◽  
Locally Advanced ◽  
Neoadjuvant Radiochemotherapy ◽  
Advanced Esophageal Cancer ◽  
Trimodality Therapy ◽  
Locally Advanced Esophageal Cancer

Abstract Background Sarcopenia, the critical depletion of skeletal muscle mass, is an independent prognostic factor in several tumor entities for treatment-related toxicity and survival. In esophageal cancer, there have been conflicting results regarding the value of sarcopenia as prognostic factor, which may be attributed to the heterogeneous patient populations and the retrospective nature of previous studies. The aim of our study was therefore to determine the impact of sarcopenia on prospectively collected specific outcomes in a subgroup of patients treated within the phase III study SAKK 75/08 with trimodality therapy (induction chemotherapy, radiochemotherapy and surgery) for locally advanced esophageal cancer. Methods Sarcopenia was assessed by skeletal muscle index at the 3rd lumbar vertebra (L3) in cross-sectional computed tomography scans before induction chemotherapy, before radiochemotherapy and after neoadjuvant therapy in a subgroup of 61 patients from four centers in Switzerland. Sarcopenia was determined by previously established cut-off values (Martin et al., PMID: 23530101) and correlated with prospectively collected outcomes including treatment-related toxicity, postoperative morbidity, treatment feasibility and survival. Results Using the published cut-off values, the prevalence of sarcopenia increased from 29.5% before treatment to 63.9% during neoadjuvant therapy (p < 0.001). Feasibility of neoadjuvant therapy and surgery was not different in initially sarcopenic and non-sarcopenic patients. We observed in sarcopenic patients significantly increased grade ≥ 3 toxicities during chemoradiation (83.3% vs 52.4%, p = 0.04) and a non-significant trend towards increased postoperative complications (66.7% vs 42.9%, p = 0.16). No difference in survival according to sarcopenia could be observed in this small study population. Conclusions Trimodality therapy in locally advanced esophageal cancer is feasible in selected patients with sarcopenia. Neoadjuvant chemoradiation increased the percentage of sarcopenia. Sarcopenic patients are at higher risk for increased toxicity during neoadjuvant radiochemotherapy and showed a non-significant trend to more postoperative morbidity.

Survivin expression in esophageal cancer: Association with histomorphological response to neoadjuvant therapy and prognosis

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4536-4536 ◽  
Author(s):  
D. Vallboehmer ◽  
E. Kuhn ◽  
J. Brabender ◽  
R. Metzger ◽  
U. Warnecke-Eberz ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Protein Expression ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Survivin Expression ◽  
Neoadjuvant Radiochemotherapy ◽  
Advanced Esophageal Cancer ◽  
Survivin Protein ◽  
Histopathologic Response ◽  
Locally Advanced Esophageal Cancer

4536 Background: The poor prognosis associated with locally advanced esophageal cancer prompted an evaluation of combined modality treatments including neoadjuvant radiochemotherapy in combination with surgery. However, it has been well established that only patients with a complete pathological response to neoadjuvant therapy will have a significant survival benefit. Therefore, predictive markers to allow a tailored radiochemotherapy are needed. The aim of this study was to examine the association of the protein expression of survivin, an inhibitor of apoptosis, with histopathologic response to neoadjuvant radiochemotherapy and prognosis of patients with locally-advanced esophageal cancer. Methods: 59 patients with esophageal cancer (cT2–4, Nx, M0) received neoadjuvant radiochemotherapy (cisplatin, 5-FU, 36 Gy) followed by esophagectomy. Histomorphologic regression was defined as major response when resected specimens contained less than 10 % and as minor response when resected specimens contained more than 10 % of residual vital tumor cells. Pre- and post-therapeutic intratumoral protein expression of survivin was determined and correlated with clinicopathologic parameters. Results: The pre-therapeutic intratumoral survivin protein expression was not associated with any clinicopathologic factor, including histopathologic response and prognosis. Survivin protein expression was significantly reduced during neoadjuvant therapy, showing lower levels in post-therapeutic tumor samples (p<0.01). Higher postoperative survivin levels were significantly associated with a higher ypT-stage (p<0.009), a poorer histopathologic response (p<0.01) and a shorter overall survival (p<0.028). Conclusions: The intratumoral protein expression of survivin was significantly down-regulated during neoadjuvant therapy, whereas a higher survivin level after pre-operative therapy was significantly associated with a worse histopathologic response and prognosis. Therapeutic strategies which are able to reduce survivin expression or to block survivin mediated pathways might increase the histopathologic response rate and prognosis in the multimodal therapy of patients with locally-advanced esophageal cancer. No significant financial relationships to disclose.

Impact of low skeletal muscle mass and density on outcomes of locally advanced esophageal cancer patients treated with radical radiotherapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16047-e16047
Author(s):  
Jiahua Lv ◽  
Ningjing Yang ◽  
Hongyuan Jia ◽  
Long Liang ◽  
Lei Wu ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Locally Advanced ◽  
Radical Radiotherapy ◽  
Advanced Esophageal Cancer ◽  
Term Survival ◽  
Locally Advanced Esophageal Cancer

e16047 Background: Low skeletal muscle mass and density are independent predictors of clinical outcomes in multiple gastrointestinal cancers. However, its effect on the long-term survival of locally advanced esophageal cancer patients undergoing radical radiotherapy is still unclear. Methods: Patients with stage II-III esophageal cancer undergoing radical radiotherapy, enrolled in a observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding overall survival (OS). Results: In total, 165 patients (75.8% males, median age 63) were included, from March 2012 to September 2017. Before radiotherapy, 26.7% patients had low skeletal muscle mass and 23.0% patients had low skeletal muscle density. After radiotherapy, 40.6% patients had low skeletal muscle mass and 30.3% patients had low skeletal muscle density.The median OS of high skeletal muscle mass and density group was significantly higher than that of low skeletal muscle mass and density group before radiotherapy (28.7 months vs 28.2 months, p = 0.041; 29.6 months vs 16.9 months, p = 0.025). The median OS of high skeletal muscle mass and density group was also significantly higher than that of low skeletal muscle mass and density group after radiotherapy (30.3 months vs 20.3 months, P = 0.012; 29.6 months vs 17.2 months, p = 0.018). Conclusions: Low skeletal muscle mass and density are associated with long-term outcome in patients undergoing radical radiotherapy. It is suggested that oncologists should pay more attention to the management of muscle mass and density of patients with esophageal cancer undergoing radiotherapy in order to improve their nutritional status and long-term survival.

630 IMPACT OF LOW SKELETAL MUSCLE MASS AND DENSITY ON OUTCOMES OF LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS TREATED WITH RADICAL RADIOTHERAPY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Yuan Wang ◽  
Ningjing Yang ◽  
Hongyuan Jia ◽  
Long Liang ◽  
Lei Wu ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Esophageal Cancer ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Mass Density ◽  
Locally Advanced ◽  
Radical Radiotherapy ◽  
Term Survival ◽  
Locally Advanced Esophageal Cancer

Abstract   Low skeletal muscle mass and density are independent predictors of clinical outcomes in multiple gastrointestinal cancers. However, its effect on the long-term survival of locally advanced esophageal cancer patients undergoing radical radiotherapy is still unclear. Methods Patients with stage II-III esophageal cancer undergoing radical radiotherapy, enrolled in a observational cohort study, were included. Skeletal muscle mass and density were measured on CT. Patients with high and low skeletal muscle mass and density were compared regarding overall survival (OS). Results 165 patients (75.8% males, median age 63) were included, from March-2012 to September-2017. Before radiotherapy, 26.7% patients had low skeletal-muscle-mass and 23.0% patients had low skeletal-muscle-density. After radiotherapy, 40.6% patients had low skeletal-muscle-mass and 30.3% patients had low skeletal-muscle-density.The median OS of high skeletal-muscle-mass/density group was significantly higher than that of low skeletal-muscle-mass/density group before radiotherapy (28.7 vs 28.2 months, p = 0.041; 29.6 vs 16.9 months, p = 0.025). The median OS of high skeletal-muscle-mass/density group was also significantly higher than that of low skeletal-muscle-mass/density group after radiotherapy (30.3 vs 20.3 months, P = 0.012; 29.6 vs 17.2 months, p = 0.018). Conclusion Low skeletal muscle mass and density are associated with long-term outcome in patients undergoing radical radiotherapy. It is suggested that oncologists should pay more attention to the management of muscle mass and density of patients with esophageal cancer undergoing radiotherapy in order to improve their nutritional status and long-term survival.

Use of PET SUV for primary tumor to predict outcome in locally advanced esophageal cancer treated with trimodality therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15559-e15559
Author(s):  
G. M. Videtic ◽  
H. M. Macley ◽  
C. Reddy ◽  
D. J. Adelstein ◽  
T. W. Rice ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Cleveland Clinic ◽  
Treatment Strategies ◽  
Response To Therapy ◽  
Advanced Esophageal Cancer ◽  
Trimodality Therapy ◽  
Significant Difference ◽  
Locally Advanced Esophageal Cancer

e15559 Background: To assess the value of the primary tumor's SUVmax (PT-SUVmax) from the staging FDG-PET as a predictor of clinical and pathologic outcomes in patients undergoing trimodality therapy for locally advanced esophageal cancer. Methods: A retrospective chart review was conducted on patients with T3/4 and/or node positive esophageal carcinoma treated at the Cleveland Clinic between 7/1/03 and 5/31/06. All patients were managed with an institutional regimen consisting of preoperative radiotherapy [30 Gy @ 1.5 Gy twice daily over two weeks] with concurrent cisplatin and 5-fluorouracil during the first week. Following resection, an identical postoperative course of concurrent chemoradiotherapy (CRT) was delivered. Pretreatment patient and tumor characteristics including PT-SUVmax were analyzed with respect to response and survival. Results: 141 patients completed preoperative CRT: 125 (88.7%) were male, median age was 60 years, 73.8% had adenocarcinoma, 79.4% had N1 disease, 81.6% underwent surgery and 63.8% completed the full regimen. Median follow-up was 17.2 months [range 0.7–75.1]. Median PT-SUVmax was 9.43 [range 0 to 47.7]. Increasing clinical stage was associated with increasing PT-SUVmaxs: for cT2 vs. cT3 and cN0 vs. cN1, PT-SUVmax cutoffs were 8 (p=0.03) and 11 (p=0.02), respectively. Median (MST) and 5-year overall survivals were 20.7 months and 27.4%, respectively. A PT-SUVmax of < vs. > 7 was a significant predictor for T downstaging (p=0.0502) and N downstaging (p=0.0467). A PT-SUVmax cutoff of 7.6 was associated with a significant difference in MST, at 29.1 and 13.0 months for PT-SUVmax< 7.6 and >7.6, respectively (p=0.0158, HR=1.82, 95%CI=1.19–2.94). On multivariate analysis, PT-SUVmax was the only significant factor associated with survival (p=0.0.314, HR=1.71, 95%CI=1.05–2.79). Conclusions: The pretreatment SUVmax of a primary esophageal cancer appears to correlate with clinical stage, pathologic response to therapy and survival. This finding could play a role in the design of clinical trials and in adapting treatment strategies. No significant financial relationships to disclose.

A National Cancer Database analysis of treatment utilization and associated outcomes in elderly patients with locally advanced esophageal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 138-138
Author(s):  
Gregory Riccardo Vlacich ◽  
Pamela Parker Samson ◽  
Stephanie Mabry Perkins ◽  
Michael Charles Roach ◽  
Parag J. Parikh ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Elderly Patients ◽  
Locally Advanced ◽  
Palliative Therapy ◽  
Female Gender ◽  
Treatment Utilization ◽  
National Cancer Database ◽  
Advanced Esophageal Cancer ◽  
Trimodality Therapy ◽  
Locally Advanced Esophageal Cancer

138 Background: Elderly patients with locally advanced esophageal cancer pose a therapeutic challenge since definitive treatment involves aggressive combined-modality therapy. Whether these individuals are offered or benefit from these approaches in the modern, trimodality era has not been widely explored. Methods: Patients ≥ 70 years old with clinical stage II and III esophageal cancer diagnosed between 1998 and 2012 were identified from the National Cancer Database and stratified based on treatment. Variables independently associated with treatment utilization were evaluated using logistic regression and mortality hazard evaluated using Cox-proportional hazards analysis. The primary aim was to compare overall survival by treatment group. The secondary aim was to identify variables associated with receiving each modality. Results: A total of 21,593 patients were identified. Median and maximum ages were 77 and 90 respectively. In 12.9%, no therapy was delivered, 24.3% received palliative therapy, 37.1% received definitive chemoradiation, 5.6% received esophagectomy alone, and 10.0% received trimodality therapy. On multivariate analysis, age ≥ 80 (OR 0.73, p < 0.001), female gender (OR 0.81, p < 0.001), and treatment at high-volume centers (OR 0.83, p = 0.008) were associated with a decreased likelihood of palliative therapy over no treatment. Age ≥ 80 (OR 0.15, p < 0.001), female gender (OR 0.80, p = 0.03), and non-Caucasian race (OR 0.63, p < 0.001) were associated with decreased trimodality use compared to definitive chemoradiation. Each treatment independently demonstrated improved survival compared to no therapy: palliative treatment (HR 0.49), concurrent chemoradiation (HR 0.36), esophagectomy (HR 0.31), trimodality therapy (HR 0.25), all p < 0.001. Conclusions: Any therapy, including palliative care, was associated with improved survival compared to no treatment in elderly patients with esophageal cancer. Subsets of patients are less likely to receive aggressive therapy based on social and institutional factors. Care should be taken to not unnecessarily deprive elderly patients of treatment that may improve survival.

Sign in / Sign up

Export Citation Format

Share Document