Definitive chemoradiotherapy may be standard treatment options in clinical stage I esophageal cancer

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 4017-4017 ◽  
Author(s):  
T. Ura ◽  
K. Muro ◽  
Y. Shimada ◽  
K. Shirao ◽  
H. Igaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Standard Treatment ◽  
Clinical Stage ◽  
Treatment Options ◽  
Stage I ◽  
Definitive Chemoradiotherapy

Definitive chemoradiotherapy may be standard treatment options in clinical stage I esophageal cancer

2004 ◽  
Vol 22 (14_suppl) ◽  
pp. 4017-4017
Author(s):  
T. Ura ◽  
K. Muro ◽  
Y. Shimada ◽  
K. Shirao ◽  
H. Igaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Standard Treatment ◽  
Clinical Stage ◽  
Treatment Options ◽  
Stage I ◽  
Definitive Chemoradiotherapy

Esophagectomy versus definitive chemoradiotherapy as initial treatment for clinical stage I esophageal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Li-Xiang Mei ◽  
Jun-Xian Mo ◽  
Yong Chen ◽  
Lei Dai ◽  
Yong-Yong Wang ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Initial Treatment ◽  
Tumor Recurrence ◽  
Clinical Stage ◽  
Stage I ◽  
Current Evidence ◽  
Cochrane Library ◽  
Definitive Chemoradiotherapy ◽  
Randomized Controlled ◽  
Significant Difference

Abstract Background Esophagectomy and definitive chemoradiotherapy are commonly used in the treatment of stage I esophageal cancer (EC). The present study aims to compare the efficacy and safety of esophagectomy and definitive chemoradiotherapy as the initial treatment for clinical stage I EC. Methods This study was registered with the International Prospective Register of Systematic Reviews (CRD42020197203). Relevant studies were identified through PubMed, Web of Science, EMBASE, and Cochrane Library from database inception to June 30, 2020. Hazard ratio (HR) with 95% confidence intervals (CI) was employed to compare overall survival (OS) and progression-free survival (PFS). Odds ratio (OR) with 95% CI was employed to compare treatment-related death, complications, and tumor recurrence. Results A total of 13 non-randomized controlled studies involving 3,346 patients were included. Compared with definitive chemoradiotherapy, esophagectomy showed an improved OS (HR 0.69, 95% CI 0.55–0.86; P < 0.001), PFS (HR 0.47, 95% CI 0.33–0.67; P < 0.001), and a lower risk of tumor recurrence (OR 0.43, 95% CI 0.30–0.61; P < 0.001). There was no significant difference in the incidence of complications (OR 1.11, 95% CI 0.75–1.65; P = 0.60) and treatment-related death (OR 1.15, 95% CI 0.31–4.30; P = 0.84) between the two treatments. Conclusions Current evidence shows esophagectomy has superior survival benefits as the initial treatment for clinical stage I EC. It is still the preferred choice for patients with clinical stage I EC. However, future high-quality randomized controlled trials are needed to validate this conclusion.

scholarly journals Changing Management of Clinical Low-Stage Testicular Cancer

2005 ◽  
Vol 5 ◽  
pp. 852-867
Author(s):  
Timothy Gilligan
Keyword(s):  
Clinical Stage ◽  
Treatment Options ◽  
Germ Cell Tumors ◽  
Late Toxicity ◽  
Additional Treatment ◽  
Stage I ◽  
Retroperitoneal Lymph Node Dissection ◽  
Testicular Germ Cell ◽  
Ongoing Research ◽  
The Individual

Stage I and II testicular germ cell tumors (GCTs) are almost always cured with appropriate treatment and most ongoing research regarding these tumors focuses on minimizing treatment toxicity. The management of clinical stage I testicular GCTs has grown more complicated due to the emergence of a brief course of chemotherapy as an additional treatment option for stage I seminomas and stage I nonseminomas. In addition, growing concern about radiation-induced cancers and other late toxicity has dulled enthusiasm for radiotherapy as a treatment for stage I seminomas. However, recent randomized trials have shown that radiotherapy doses and field sizes can be lowered without compromising cure rates and it is possible that this reduction in radiation exposure will reduce the rate of secondary cancers. At this point in history, stage I patients have three treatment options following radical orchiectomy: adjuvant (sometimes called “primary”) chemotherapy (carboplatin for seminomas and the combined regimen of bleomycin, etoposide, and cisplatin for nonseminomas), surveillance, and either retroperitoneal lymph node dissection (for nonseminomas) or radiotherapy (for pure seminomas). Clinical studies have made it possible to identify subgroups of patients at high and low risk for relapse and this has made it possible to tailor treatment decisions to the individual patient's postorchiectomy relapse risk.

PS02.039: SERUM CRP LEVEL IS A PROGNOSTIC FACTOR OF ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 131-131
Author(s):  
Daisuke Ishioka ◽  
Masaaki Saito ◽  
Jun Takahashi ◽  
Tamotsu Obitsu ◽  
Hirokazu Kiyozaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Standard Dose ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Complete Response ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
History Of ◽  
Serum Crp

Abstract Background In advanced esophageal cancer, definitive combined chemoradiotherapy (d-CRT) is considered to be one of standard therapy in Japan. However, there have been few studies of the correlation of clinical factors and response to chemoradiotherapy. The aim of this study is to clarify the correlation of serum CRP level and response to definitive chemoradiotherapy for advanced esophageal cancer. Methods A total of 78 patients with clinical stage II/III esophageal cancer who were treated with d-CRT at our institute from 2002 to 2014 were retrospectively reviewed. 57 patients received chemotherapy using low-dose 5-FU and cisplatin, and remaining 19 patients received chemotherapy using standard-dose 5-FU and cisplatin according to the protocol described in the RTOG trial combined with radiation therapy. The patients were stratified by response to chemoradiotherapy by two groups. 60 patients (54 patients had a complete response and 6 had a partial response) were in Responder group, and 18 patients (7 patients had a stable disease and 11 had a progressive disease) were in Non- responder group. The correlation of survival rate and serum CRP level before d-CRT was evaluated. Results At the time of analysis, the median follow-up period was 32 months (range 3–124 months). The overall survival of the Responder group was significantly better than that of Non- responder group (P < 0.001). Univariate analysis showed that white blood cell > 8000/m3 (P = 0.036), CRP > 1.0mg/dl (P = 0.002), adventitia invasion (P = 0.04) and history of the smoking (P = 0.037) were predictive for response of d-CRT. Multivariate analyses identified serum CRP level (P = 0.002) as independent prognostic factors for response of d-CRT. Conclusion Our findings suggest that serum CRP level may be a useful marker to predict a response to definitive chemoradiotherapy. However, further examinations in the future will be necessary to determine its efficacy. Disclosure All authors have declared no conflicts of interest.

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.

Patterns of care and treatment outcomes of patients with stage I esophageal cancer: A National Cancer Database analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4035-4035
Author(s):  
Amy Catherine Moreno ◽  
Ning Zhang ◽  
Steven H. Lin ◽  
Sharon Hermes Giordano
Keyword(s):  
Esophageal Cancer ◽  
Clinical Stage ◽  
Local Therapy ◽  
The United States ◽  
Stage I ◽  
Patterns Of Care ◽  
Median Income ◽  
Comorbidity Score ◽  
Cancer Data ◽  
Definitive Therapy

4035 Background: The aim of this study was to examine current patterns of care and associated outcomes for patients with stage I esophageal cancer (EC) treated in the United States. Methods: The National Cancer Data Base (NCDB) was queried for patients diagnosed with clinical stage T1-2N0 EC from 2004-2012. Patients were categorized into four treatment groups: observation without definitive therapy (Obs), chemoradiotherapy (CRT), local excision (LE), and esophagectomy (Eso). Patient, tumor, and treatment parameters were compared between groups. Kaplan-Meier 5-year overall survival (OS) estimates, postoperative 30- and 90-day mortality comparisons, and multivariate Cox proportional hazards modeling are reported. Results: A total of 5,460 patients met the criteria. Of these, 21% were observed, 14% underwent CRT, 23% LE, and 42% Eso. Median age and follow up were 67 years and 28 months, respectively. Eso was the primary treatment for patients of age ≤ 80 while 48% of patients age > 80 were observed. Age, race, comorbidity score, tumor location within the esophagus, type of medical insurance, median income, type of facility (academic vs. non-academic), and distance from treating facility were significant factors for predicting receipt of local therapy over observation. Postoperative 30-day mortality between the LE and Eso groups was 0.5% and 2.9%, respectively ( P< .001), which increased to 1.4% and 5.5% at 90 days ( P< .001). Five-year OS was 21% for Obs, 26% CRT, 64% LE, and 63% Eso ( P < .001). Multivariate analyses demonstrated improved OS with any form of local definitive therapy: CRT ( HR: 0.54, 95% CI [0.48 - 0.61], P< .001), LE ( HR: 0.24, [0.20 - 0.27], P< .001), Eso (HR: 0.31, [0.28 - 0.35], P< .001). Age, comorbidity score, facility type, distance, median income quartile, and insurance status were also independently associated with OS. Conclusions: Management of stage I EC is influenced by several demographic and socioeconomic factors. Clinical observation yields suboptimal outcomes compared to any local therapy, and a surgical approach should be considered over CRT whenever feasible.

Real-world outcomes of esophagectomy versus chemoradiotherapy for clinical stage I esophageal squamous cell carcinoma.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 178-178
Author(s):  
Hiroki Yukami ◽  
Kentaro Sawada ◽  
Hisashi Fujiwara ◽  
Saori Mishima ◽  
Daisuke Kotani ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Real World ◽  
Standard Treatment ◽  
Clinical Stage ◽  
Stage I ◽  
Comparable Efficacy ◽  
Tumor Depth

178 Background: Recently, JCOG0502 trial have shown a comparable efficacy with chemoradiotherapy (CRT) and esophagectomy as standard treatment in patients with clinical stage (cStage) I esophageal squamous cell carcinoma (ESCC), showing the standard treatment option of CRT. However, there is few reports for comparison of clinical outcomes with these treatments in real-world. The aim of this study was to clarify the real-world outcomes in cStage I ESCC who performed with CRT or esophagectomy. Methods: This retrospective study included patients with clinical stage I ESCC who received thoracoscopic or open esophagectomy with three-field lymph node dissection or CRT mainly consisted of 5-fluorouracil and platinum with concurrent radiotherapy (50.4 Gy/28Fr or 60 Gy/30Fr) between 2009 and 2017 at National Cancer Center Hospital East. Survival outcomes were calculated using the Kaplan-Meier method, and the differences were evaluated using the log-rank test. Results: Among a total of 156 patients, 128 were male and median age was 68 years old. 120 and 36 patients underwent esophagectomy and CRT, respectively. ECOG performance status 0/1/2 were 138/12/6 patients. Tumor location was Ut/Mt/Lt in 16/87/53 patients. Clinical tumor depth (MM-SM1/SM2-SM3) were 33/123 patients. Patients’ characteristics were similar among treatment groups, except clinical tumor depth (SM2-3; 84.2% in esophagectomy group vs. 61.1% in CRT group, p = 0.005). All patients underwent radical surgery in esophagectomy group, while three patients (8.3%) in CRT group were received additional esophagectomy or endoscopic resection due to residual disease. With a median follow-up of 72 months, 5-year overall survival (OS) and progression-free survival rate were 81.5%/77.0% in esophagectomy group and 82.6/74.4% in CRT group (p = 0.89 and p = 0.48). In safety profile, grade 3 or higher stenosis was observed in 21.7% of esophagectomy group. There was no treatment-related death in both groups. In subgroup analysis for OS, elderly patients (75 years and older) tended to have better 5-year OS rate in CRT group (76.9% in esophagectomy group vs. 81.8% in CRT group), while younger patients ( < 75 years) showed comparable 5-year OS rate in both groups (82.4% in esophagectomy group vs. 82.9% in CRT group). Conclusions: Real-world data reproduced the results of clinical trial, supporting CRT as one of the standard treatment options in patients with cStage I ESCC.

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