Outcomes of recurrence after complete response to definitive chemoradiotherapy for stage II/III (non–T4) esophageal squamous cell carcinoma.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 179-179
Author(s):  
Hiroki Kuwabara ◽  
Ken Kato ◽  
Yusuke Sasaki ◽  
Naoki Takahashi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Survival Time ◽  
Cox Regression ◽  
Performance Status ◽  
Locally Advanced ◽  
Complete Response ◽  
Advanced Esophageal Cancer ◽  
Locoregional Failure ◽  
Distant Failure ◽  
Locally Advanced Esophageal Cancer

179 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. We examined patterns of recurrence and clinical outcomes in patients with recurrence after complete response (CR) to dCRT. Methods: We retrospectively investigated 238 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2010. From among these patients we selected 95 who had developed disease recurrence after CR. Overall survival was defined as survival time from recurrence to death and was calculated by using the Kaplan-Meier method. Univariate and multivariate analyses were performed with the Cox regression model to determine prognostic factors for survival. Results: The characteristics of the 95 patients were as follows: male: female = 84:11; median age = 64 years (range 46 to 80); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 20/31/44; and performance status at recurrence (0/1) = (51/44). Primary CRT consisted of 5-FU+cisplatin (n = 87), 5-FU+nedaplatin (n = 3), S-1+cisplatin (n = 3), 5-FU+cisplatin+ nimotuzumab (n = 1), or docetaxel (n = 1). The pattern of recurrence was locoregional failure (n = 53) or any distant failure (n = 42). Median time from the start of dCRT to recurrence was 13.0 months, and median survival time from recurrence to death was 19.6 months. Median survival time according to the pattern of failure was 34.7 months (locoregional failure) or 17.0 months (any distant failure). Application of the Cox regression model, including the additional prognostic variables of age, ECOG performance status, number of organs in which metastases were present, and LDH, revealed that any distant failure (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.2 to 4.1; P = 0.01) and recurrence before 13.0 months (HR 2.1; 95% CI 1.2 to 3.6; P = 0.01) were predictors of poor overall survival. Conclusions: Early recurrence and any distant failure were associated with poor prognosis after CR to dCRT for locally advanced esophageal cancer.

Clinical characteristics of recurrent esophageal cancer after definitive chemoradiotherapy for stage II//III (non T4) esophageal squamous cell cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 137-137
Author(s):  
Akiko Nishikawa ◽  
Ken Kato ◽  
Yoshitaka Honma ◽  
Satoru Iwasa ◽  
Atsuo Takashima ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Stage ◽  
Locally Advanced ◽  
Disease Recurrence ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
Locoregional Failure ◽  
Distant Failure ◽  
Time To Recurrence ◽  
Locally Advanced Esophageal Cancer

137 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. No standard treatment strategy exist for recurrence after complete response (CR) to dCRT. We examined patterns of recurrence and clinical outcomes in patients with disease recurrence after dCRT. Methods: We retrospectively investigated 197 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2008. We analyzed data from the 69 patients who had developed disease recurrence after CR, excluding 11 who died of other causes. Time to event was calculated by the Kaplan-Meier method, and the Cox proportional hazard model was used in univariate and multivariate analyses. Results: Characteristics of the 69 patients were as follows: male: female = 61:8; median age = 65 years (range 47 to 82); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 15/22/32; and performance status at recurrence (0/1/2) = (35/32/2). Primary CRT consisted of 5-FU+cisplatin (n = 66), 5-FU+nedaplatin (n = 2), or S-1+cisplatin (n = 1). The pattern of recurrence was locoregional failure (n = 35), or any distant failure (n = 34). Median time to recurrence from the start of dCRT was 13.6 months, and median survival time after recurrence was 17.4 months. Median survival time according to pattern of failure was 27.5 months (locoregional failure), and 17.4 months (any distant failure). In the univariate analysis, locoregional failure (HR 0.51), time to recurrence >13 months (HR0.38), clinical stage II (HR0.48), and any treatment for recurrence (HR: 0.15) were associated with better prognosis after recurrence. In the multivariate analysis, only time to recurrence (>13 months) was associated with better prognosis with HR 0.31(95%CI:0.14-0.66) Conclusions: Our study suggested that patients with early recurrence have a poor prognosis. More intensive treatment is needed to improve survival.

Phase II cisplatin, irinotecan, cetuximab and concurrent radiation therapy followed by surgery for locally advanced esophageal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4064-4064 ◽  
Author(s):  
P. C. Enzinger ◽  
T. Yock ◽  
W. Suh ◽  
P. Fidias ◽  
H. Mamon ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Phase Ii ◽  
Locally Advanced ◽  
Complete Response ◽  
Tumor Location ◽  
Advanced Esophageal Cancer ◽  
Early Results ◽  
Ecog Ps ◽  
Locally Advanced Esophageal Cancer

4064 Background: Weekly irinotecan, cisplatin, and concurrent radiation therapy is a well-tolerated, active regimen in locally advanced esophageal cancer. (Ilson. JCO 2003) Cetuximab, an EGFR inhibitor, is a potent radiation sensitizer in head and neck cancer. (Bonner. Proc ASCO 2004) Methods: In this phase II trial, patients (pts) with T2–4N0–1M0–1A esophageal adenocarcinoma (A) or squamous cell carcinoma (S) receive 5040 cGy/28 fractions of radiation therapy (RT) and concurrent weekly cisplatin 30mg/m2 plus irinotecan 65 mg/m2 on weeks 1, 2, 4, and 5, followed by surgery 4–8 weeks after completion of RT. Additionally, pts receive weekly infusions of cetuximab 250 mg during RT, up to one week before surgery, and for 6 months following surgery. Results: Seventeen pts have been entered: male: female = 14:3, median age 54, ECOG PS 0:1 = 6:11, A:S = 17:0, stage IIA:IIB:III:IVA = 6:1:8:2, tumor location-esophagus-mid:lower:gastroesophageal junction = 1:4:12, >10% weight loss-yes:no = 8:9. Of 17 pts entered, 15 pts have proceeded to surgery, 1 pt died from Aspergillus infection resulting in respiratory failure and sepsis, and 1 pt is pending surgery. Of the 15 pts who underwent surgery, 2 (13%) had a complete pathologic response; pathologic stage for other pts: 0 = 1, I = 3, IIA = 3, IIB = 1, III = 4, IV = 1. Grade III/IV toxicity (17 pts) was: diarrhea 9 pts, neutropenia 9 pts, febrile neutropenia 5 pts, anorexia 5 pts, vomiting 4 pts, fatigue 3 pts, mucositis 1 pt. Chemotherapy dose attenuation was required for diarrhea in 5 pts, for neutropenia in 4 pts, and for folliculitis in 1 pt. One patient was removed from study during week 6 for prolonged diarrhea/ dehydration. Due to the 2-step design of the trial, accrual is on hold pending a 3rd required pathologic CR in the first 17 patients. Conclusions: Compared to other trials of irinotecan, cisplatin, radiation therapy, and surgery in similar groups of esophageal cancer patients, early results for this combination with cetuximab suggest a lower complete response rate and higher overall toxicity. Additional data will be available at ASCO. Supported by Bristol-Myers Squibb. No significant financial relationships to disclose.

Survival differences between preoperative and postoperative radiation in esophageal cancer treated with combined modality therapy: A SEER analysis.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 78-78
Author(s):  
Andrzej Pawel Wojcieszynski ◽  
Abigail Berman Milby ◽  
John Peter Plastaras ◽  
James M. Metz ◽  
Smith Apisarnthanarax
Keyword(s):  
Esophageal Cancer ◽  
Cox Regression ◽  
Combined Modality Therapy ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Survival Outcomes ◽  
Advanced Esophageal Cancer ◽  
Carcinoma Of The Esophagus ◽  
Survival Differences ◽  
Locally Advanced Esophageal Cancer

78 Background: The effect of radiation therapy (RT) sequencing with surgery on clinical outcomes for locally advanced esophageal cancer patients is unclear. We hypothesized that RT given prior to surgery has superior survival outcomes compared to RT delivered after surgery. Methods: Patients with the following inclusion criteria were identified within 17 Surveillance, Epidemiology, and End Results (SEER) registries from 1988-2006: adenocarcinoma or squamous cell carcinoma of the esophagus, esophagectomy, and RT. Data on demographics, tumor characteristics, and survival outcomes were extracted and compared between patients receiving preoperative and those receiving postoperative RT. Cox regression univariate and multivariate analyses were performed to identify parameters that were associated with cause-specific (CSS) and overall survival (OS). Results: A total of 2,579 patients met the defined criteria. Of these patients, 1,689 received preop RT and 890 received postop RT. Patients receiving preop RT compared to postop RT had improved 5-yr CSS (41% vs. 31%, p<0.0001) and OS (33% vs. 23%, p<0.0001). On univariate analysis, RT sequence, histology, T stage, nodal status, number lymph nodes examined, age, gender, marital status, race, and county income were significant independent predictors of OS. On multivariate analysis ( table ), preop RT continued to remain statistically significant for OS (HR 0.88; p = 0.034). Conclusions: Preoperative RT is associated with superior overall and cause-specific survival compared to postoperative RT and should be the preferred approach in combination with surgery for locally advanced esophageal cancer. [Table: see text]

Low expression of bax predicts poor prognosis in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 4597-4597
Author(s):  
S. Kang ◽  
J. Han ◽  
K. Lee ◽  
J. Choi ◽  
J. Park ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
High Expression ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
Clinical Complete Response ◽  
Galectin 3 ◽  
Low Expression ◽  
Locally Advanced Esophageal Cancer

4597 Background: The present study evaluated the prognostic significance of apoptosis-related proteins, p53, bcl-2, bax, and galectin-3 in patients with locally advanced esophageal cancer treated with definitive chemoradiotherapy (CRT). Methods: Sixty-three patients with locally advanced esophageal cancer (stage II-IV) were treated with definitive CRT using 5-fluorouracil and cisplatin combined with radiotherapy. Pretreatment tumor biopsy specimens were analyzed for p53, bcl-2, bax, and galectin-3 expression by immunohistochemistry. Results: High expression of bax, p53, bcl-2, and galectin-3 was observed in 67%, 47%, 24%, and 29% of patients, respectively. The median overall survival (OS) of total patients was 14 months with 16% of 3-year OS. High expression of p53, bcl- 2, and galectin-3 did not demonstrate correlation with clinicopathologic characteristics, including patient outcome. Low expression of bax was significantly correlated with clinical complete response (p=0.023). Low expression of bax was also associated with poor OS (median, 8 months vs. 16 months; P=0.0008) in univariate analysis. In multivariate analysis, low expression of bax was the most significant independent predictor of poor OS (p=0.01) followed by clinical complete response and low radiation dose. Conclusions: Low expression of bax was significantly associated with the poor survival of patients with locally advanced esophageal cancer treated with CRT using 5-fluorouracil and cisplatin. Immunohistochemical staining for bax with a pretreatment biopsy specimen might be useful to select the optimal treatment options for these patients. No significant financial relationships to disclose.

Concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil (5 FU) and cisplatin for locally advanced resectable esophageal cancer: A retrospective study.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 119-119
Author(s):  
Khaldoun Almhanna ◽  
Sarah Hoffe ◽  
Ravi Shridhar ◽  
Jonathan R. Strosberg ◽  
William R. Dinwoodie ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Surgical Resection ◽  
Locally Advanced ◽  
Complete Response ◽  
R0 Resection ◽  
Severe Toxicity ◽  
Advanced Esophageal Cancer ◽  
Resectable Esophageal ◽  
Grade 3 ◽  
Locally Advanced Esophageal Cancer

119 Background: Neoadjuvant CCRT has become the standard treatment for esophageal cancer. Most clinicians use a conventional cisplatin/5 FU combination which is associated with moderate to severe toxicity. For the last 15 years we have used contiuous low-dose 5-FU combined with two doses of cisplatin. Methods: Between July 1997 and June 2012, 155 patients with locally advanced esophageal cancer (T3 or N1 and higher), received CCRT consistent of cisplatin 75 mg/m2 on day 1 and day 29 and continuous infusion of 5-FU (225 mg/m2/day) on the days of radiation. Results: Median age of patients was 63 year (30-76).Seventeen percent of pts were female and 85% had adenocarcinoma. (3, 34, 86 and 31 pts had stage I, II, III and IVa disease respectively. One hundred and twenty seven pts had N1 disease. Radiation dose (RT) ranged from 45-60 Gy (median 56Gy). Median weight loss was 6.5%. All patients completed treatment. 20% of patients had >=grade 3 toxicity, with 29 patients requiring hospital admission. 53% of patients had surgical resection between 37-149 days following CCRT (median 62 days). R0 resection was achieved in 96% of patients. A pathological complete response was achieved in 38 of 83 pts (45%) who underwent surgical resection. With a median follow up of 26 months (1.2 -144 months), 36% of pts recurred and total of 50% died. Conclusions: Compared to conventional chemotherapy regimen, our CCRT regimen for locally advanced esophageal cancer is well tolerated and associated with a high pathological response rate.

FA08.01: MORTALITY AND REFRAINMENT FROM ESOPHAGECTOMY IN ESOPHAGEAL CANCER PATIENTS THAT STARTED NEOADJUVANT CHEMORADIOTHERAPY: A POPULATION-BASED COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 15-15
Author(s):  
Alicia Borggreve ◽  
Peter Van Rossum ◽  
Stella Mook ◽  
Nadia Haj Mohammad ◽  
Richard Hillegersberg ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cohort Study ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Population Based ◽  
Advanced Esophageal Cancer ◽  
Population Based Study ◽  
Locally Advanced Esophageal Cancer

Abstract Background Esophagectomy functions as the cornerstone of the curative treatment for locally advanced esophageal cancer. The addition of neoadjuvant chemoradiotherapy (nCRT) to surgery improves survival, but can be accompanied by substantial toxicity on the other hand. This cohort study describes the consequences of nCRT for esophageal cancer in terms of mortality (during or after the course of nCRT) in real-world clinical practice, as well as the proportion of patients that do not proceed to planned esophagectomy after finishing nCRT. Methods All patients that started nCRT (carboplatin/paclitaxel with 41.4 Gy) for primary, locally advanced, esophageal cancer in 2015 were included from the nationwide population-based cancer registry. Outcome measurements were mortality during or within 90 days after neoadjuvant therapy (and before planned esophagectomy), as well as refrainment from planned esophagectomy after starting nCRT and the reasons for cancelled esophagectomy. Results Some 740 patients that started nCRT for esophageal cancer were included (Table 1). A total of 13 (1.8%) patients died during or within 90 days after nCRT (before planned esophagectomy). A total of 79 (10.7%) patients that started nCRT did not proceed to esophagectomy. The most frequently reported reasons for not proceeding to esophagectomy were tumor progression (4.6%, n = 34), performance status (2.7%, n = 20), and patients’ request (1.8%, n = 13). Conclusion In this population-based study, 1 in 10 (10.7%) patients that started nCRT for locally advanced esophageal cancer did not undergo esophagectomy. Further research should aim to investigate whether this patient group can be selected prior to treatment, and if interventions and counseling will result in a larger proportion of patients who will undergo surgery. Disclosure All authors have declared no conflicts of interest.

Sign in / Sign up

Export Citation Format

Share Document