Can induction chemotherapy improve dysphagia in locally advanced esophageal/GEJ cancer?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 148-148
Author(s):  
Elizabeth Won ◽  
David H. Ilson ◽  
Jessica Herrera ◽  
Yelena Yuriy Janjigian ◽  
Geoffrey Yuyat Ku ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Concurrent Chemoradiation ◽  
Tube Placement ◽  
Average Weight ◽  
Feeding Tubes ◽  
Presenting Symptoms

148 Background: Dysphagia is one of the most common presenting symptoms in esophageal cancer (EC) and can lead to significant nutritional decline, which is associated with increased toxicity and poor outcomes. Invasive feeding tubes or endoscopic stents are frequently used to improve nutrition in this setting. We evaluated the role of induction chemotherapy prior to concurrent chemoradiation as presurgical treatment in improving dysphagia. Methods: Retrospective analysis of 4 prospective studies conducted at MSKCC with induction chemotherapy followed by concurrent chemoradiation and surgery in locally advanced esophageal/GEJ cancer. Regimens included cisplatin/paclitaxel, cisplatin/irinotecan, and cisplatin/irinotecan/bevacizumab. Dysphagia was graded prospectively using a validated dysphagia scale. Response of dysphagia and nutritional status to induction chemotherapy was evaluated. Results: Of 161 patients (pts) undergoing induction chemotherapy, [median age 59(21-76), KPS 90 (70-100), 77% adenocarcinoma], 121 (76%) had dysphagia, with 59(37%) having grade 2 dysphagia or higher (20% Stage II, 80% Stage III). 6(4%) required EGD dilatation/stent and none required feeding tube placement prior to treatment. 22% patients had>10% body weight loss prior to treatment and average weight loss in all pts was 4.3kg. After induction chemotherapy, 104 (64%) had improvement in dysphagia. This was associated with a weight gain in 42% of pts. Only 7(4%) had worsening dysphagia after induction chemotherapy: 4/7 required feeding tubes (2% of all pts), 2/7 underwent endoscopic dilatation or stent (1% of all pts). 6/7 of these pts with worsening dysphagia had poor short term outcomes after induction treatment: 2/7 progressive disease, 3/7 unresectable at surgery, 1/7 post-operative death. Conclusions: Induction chemotherapy prior to concurrent chemoradiation for locally advanced esophageal cancer can effectively improve swallowing and nutritional status, while mitigating need for feeding tubes or stents in patients with significant dysphagia. Post-induction dysphagia may be prognostic and merits further investigation.

A nutritional management algorithm in older patients with locally advanced esophageal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16038-e16038
Author(s):  
Ryan H. Moy ◽  
Shalom Sabwa ◽  
Steven Brad Maron ◽  
Marina Shcherba ◽  
Arlyn J. Apollo ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Induction Chemotherapy ◽  
Enteral Feeding ◽  
Nutritional Assessment ◽  
Locally Advanced ◽  
Tube Placement ◽  
Nutritional Management ◽  
Management Algorithm

e16038 Background: Esophageal cancer primarily affects older adults, who are at highest risk for poor nutritional status due to medical comorbidities, physiological changes of aging and geriatric issues such as altered cognition and mobility. Malnutrition is correlated with poor outcomes in patients with esophageal cancer; however, standardized nutritional interventions are not commonly utilized. Therefore, we performed a feasibility study of a nutritional management algorithm with risk-based guidelines for older patients with esophageal cancer receiving chemoradiation (CRT). Methods: Elderly patients (age ≥ 65 years old) with locally advanced esophageal or gastroesophageal junction (GEJ) cancer receiving induction chemotherapy and preoperative or definitive CRT were eligible for enrollment on this single center study. Patients completed baseline nutritional assessment using the Mini Nutritional Assessment (MNA) screening scale, and patients who were at risk for malnutrition or malnourished were referred to a clinical dietician for evaluation and counseling. Nutritional status was reassessed after induction chemotherapy, and patients with severe malnutrition were to be referred for enteral feeding tube placement prior to CRT. The primary objective was to determine the feasibility of the nutritional management algorithm based on completion rates of nutritional assessment, clinical dietician referral and enteral feeding. Secondary endpoints included toxicity, functional status and quality of life assessment. Results: Twenty elderly patients with locally advanced esophageal cancer were enrolled, and fourteen patients met criteria for clinical dietitian referral based on poor baseline nutritional status. Induction chemotherapy was associated with improved dysphagia, with 92% of patients reporting improvement or resolution of symptoms. There were no patients who met criteria for enteral feeding prior to CRT based on the guidelines, and only one patient (5%) required feeding tube placement during CRT. In total, 17 patients (85%) completed the nutritional management algorithm and finished the planned treatment course. Rates of hospitalization, grade ≥2 esophagitis, grade ≥3 toxicity and early CRT discontinuation were similar between patients with normal and abnormal baseline nutrition. Conclusions: This study demonstrates that a risk-based nutritional management algorithm is feasible in elderly patients with esophageal cancer. The induction chemotherapy approach may ameliorate dysphagia, reduce the need for enteral feeding and facilitate CRT completion in this nutritionally vulnerable population. Clinical trial information: NCT02027948.

Use of prophylactic percutaneous endoscopic gastrostomy (pPEG) tube in head and neck cancer (HNC) patients and correlation of weight loss with treatment interruptions.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17509-e17509
Author(s):  
Deepali Pandey ◽  
Lisa Gibbs ◽  
Kamal Kant Sahu ◽  
Ahmad Daniyal Siddiqui
Keyword(s):  
Weight Loss ◽  
Statistical Tests ◽  
Locally Advanced ◽  
T Test ◽  
Tube Placement ◽  
Optimal Timing ◽  
Average Weight ◽  
Average Percentage ◽  
Treatment Interruptions ◽  
Peg Tube

e17509 Background: HNC patients are at risk for weight loss which can cause treatment interruptions, and poorer outcomes. There is no consensus on optimal timing of PEG tube placement in HNC patients undergoing concurrent ChemoTherapy (CT) and RadioTherapy (RT). The aim of this study is to determine if pPEG tube would decrease weight loss (WL) in HNC patients. We also analyzed correlation between WL and CT interruptions (CTI), RT interruptions (RTI), and intravenous fluid requirements (IVFr). Methods: This is a prospective study. A total of 16 HNC patients undergoing concurrent CT, RT were included. Before treatment initiation, a PEG tube placement was recommended as a mode of nutrition. 13 patients chose to get pPEG tube and 3 refused. We collected data on weight at 0 and 2 months, CTI, RTI, and IVFr. CTI included missed as well as reduced chemotherapy doses. RTI included missed radiations. Statistical tests used - t-test, Levene’s test for equality of variances and point biserial correlation. Results: Median age - 63 years; Gender: 14 Male/2 Female; Tumor location - Oral cavity - 31.3%; Oropharynx - 43.7%; Larynx - 25%; Nasopharynx and Hypopharynx- 0%. Stages were - II (6.2%), III (37.5%) and IV (56.3%). 2 patients were non-smoker and 4 were Human Papilloma Virus positive. Mean WL(lb) in pPEG (n = 11) vs non-PEG (n = 3) group was 10.3 vs 20.3 (p = 0.045, one-tailed t-test). Average percentage of WL: PEG vs non-PEG - 5.8 vs 8.2; RTI vs not - 8.9 vs 5.3; CTI vs not - 6.9 vs 5.8; IVFr vs not - 6.8 vs 4.5 ( > 7.5% WL over 3 months is significant (ADA/ASPEN)). CTI, RTI and IVFr were positively correlated to WL (correlation coefficient: 0.16; 0.32; 0.17 respectively). CTI and RTI in pPEG group were 23.1% and 38.5% respectively. CTI and RTI in non-PEG group were 33.3% and 66.7% respectively. 2 patients in pPEG group had average weight gain of 2.75 lb. Only 3 patients had PEG tube related complications - infections and clogging. Conclusions: pPEG tube decreases weight loss in locally advanced HNC patients. Patients with higher weight loss had more chemoradiation interruptions and IVFr. HNC patients undergoing concurrent CT, RT should be encouraged to maintain weight and get a PEG tube.

Effect of nutritional status and support on survival in esophageal cancer patients undergoing combined modality therapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20641-e20641
Author(s):  
J. P. Plastaras ◽  
J. C. Haynes ◽  
R. Mick ◽  
L. M. Hertan ◽  
A. I. Urdaneta ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Cox Regression ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Nutritional Supplements ◽  
Curative Intent ◽  
Cox Regression Analysis ◽  
The Impact

e20641 Background: Baseline nutritional status is associated with clinical outcomes in esophageal cancer. Moreover, nutritional support during chemoradiation has been shown to improve outcomes in other disease sites. This retrospective study evaluated the impact of nutritional interventions and baseline nutritional status on outcomes in patients (pts) with locally advanced esophageal cancer. Methods: A retrospective review was performed of 132 pts treated with curative intent using radiation (RT) between 1986 and 2007 at the Hospital of the University of Pennsylvania. The median age of the population was 60 years (range: 33–86). Esophagectomy was performed in 70%, with adjuvant RT in 60% and neoadjuvant RT in 40%. Concurrent chemotherapy was given to 85% of the group. Nutritional counseling was provided to 83% of pts. During RT, oral or enteral nutritional supplements were provided to 77% of pts and intravenous fluids (IVF) were given to 38%. Median follow-up was 14.1 months. Results: Median survival from end of radiation was 1.5 yrs. Median absolute and percentage weight loss during RT were 6.2 lbs and 3.8%, respectively. Median percentage decrease in hemoglobin and albumin were 5.7% and 9.1%, respectively. Univariable Cox regression analysis demonstrated a statistically significant association between weight loss of ≥5 lbs during RT and worse survival (HR 1.74, 95% CI 1.09 - 2.79, p=0.02). Decrease in hemoglobin of 5% or more (HR 1.22, 95% CI 0.59 - 2.54) and decrease in albumin of 10% or more (HR 1.09, 95% CI 0.48 - 2.48) were not associated with survival. Patients who received only nutritional supplements during RT survived significantly longer (p=0.03) than pts who received IVF regardless of nutritional supplementation (HR 2.12, 95% CI 1.12 - 4.01) or pts who received neither nutritional supplements nor IVF (HR 1.8, 95% CI 1.03 - 3.14). Conclusions: Weight loss during RT predicted for worse survival. Nutritional factors before and during RT may be important in outcomes in patients with esophageal cancer and may be modifiable. The use of IVF may be a potential indicator of worse prognosis. Future prospective studies should consider these factors in trial design. No significant financial relationships to disclose.

Phase I Trial of Escalating-Dose Irinotecan Given Weekly With Cisplatin and Concurrent Radiotherapy in Locally Advanced Esophageal Cancer

2003 ◽  
Vol 21 (15) ◽  
pp. 2926-2932 ◽  
Author(s):  
David H. Ilson ◽  
Manjit Bains ◽  
David P. Kelsen ◽  
Eileen O’Reilly ◽  
Martin Karpeh ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Phase I ◽  
Induction Chemotherapy ◽  
Phase Ii ◽  
Phase I Trial ◽  
Locally Advanced ◽  
Phase Iii ◽  
Concurrent Radiotherapy ◽  
Minimal Toxicity ◽  
Grade 3

Purpose: To identify the maximum-tolerated dose and dose-limiting toxicity (DLT) of weekly irinotecan combined with cisplatin and radiation in esophageal cancer. Patients and Methods: Nineteen patients with clinical stage II to III esophageal squamous cell or adenocarcinoma were treated on this phase I trial. Induction chemotherapy with weekly cisplatin 30 mg/m2 and irinotecan 65 mg/m2 was administered for four treatments during weeks 1 to 5. Radiotherapy was delivered weeks 8 to 13 in 1.8-Gy daily fractions to a dose of 50.4 Gy. Cisplatin 30 mg/m2 and escalating-dose irinotecan (40, 50, 65, and 80 mg/m2) were administered on days 1, 8, 22, and 29 of radiotherapy. DLT was defined as a 2-week delay in radiotherapy for grade 3 to 4 toxicity. Results: Minimal toxicity was observed during chemoradiotherapy, with no grade 3 or 4 esophagitis, diarrhea, or stomatitis. DLT caused by myelosuppression was seen in two of six patients treated at the 80-mg/m2 dose level, thus irinotecan 65 mg/m2 was defined as the recommended phase II dose. Dysphagia improved or resolved after induction chemotherapy in 13 (81%) of 16 patients who reported dysphagia before therapy. Only one patient (5%) required a feeding tube. Six complete responses (32%) were observed, including four pathologic complete responses in 15 patients selected to undergo surgery (27%). Conclusion: Cisplatin, irinotecan, and concurrent radiotherapy can be administered on a convenient schedule with relatively minimal toxicity and an acceptable rate of complete response in esophageal cancer. Further phase II evaluation of this regimen is ongoing. A phase III comparison to fluorouracil or taxane-containing chemoradiotherapy should be considered.

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