The effect of adjuvant chemotherapy in patients without local nodal metastases following neoadjuvant chemoradiotherapy and esophagectomy for locally advanced esophageal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 111-111
Author(s):  
Christopher Duane Nevala-Plagemann ◽  
Samual Francis ◽  
Courtney Christine Cavalieri ◽  
Shane Lloyd ◽  
Ignacio Garrido-Laguna
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Therapy ◽  
Locally Advanced ◽  
Postoperative Chemotherapy ◽  
National Cancer Database ◽  
Nodal Metastases ◽  
Advanced Esophageal Cancer ◽  
Locally Advanced Esophageal Cancer

111 Background: Neoadjuvant chemoradiation therapy (CRT) followed by esophagectomy is the current standard of care for patients with locally advanced esophageal cancer. The potential benefit of additional postoperative chemotherapy is still under investigation. In this study, we utilized the National Cancer Database to assess the effect of adjuvant chemotherapy in patients who were found to have node negative disease (pN0) following surgery. Methods: Patients with locally advanced esophageal cancer who received neoadjuvant CRT followed by esophagectomy from 2004 to 2014 were retrospectively identified using the National Cancer Database. Patients who were postoperatively staged as pN0 were then separated based on whether or not they received adjuvant chemotherapy. Using Kaplan-Meier estimation and a multivariate cox regression analysis, the overall survival of those who received adjuvant therapy was then compared to those who received neoadjuvant CRT alone. Results: 3,159 patients with locally advanced esophageal cancer underwent neoadjuvant CRT and were found to be pN0 following surgery. 119 of these patients received postoperative chemotherapy. The 1, 5, and 8-year overall survival in those receiving adjuvant therapy was 95.9%, 49.9%, and 47.7% compared to 85.8%, 44.6%, and 33.0% in those receiving neoadjuvant CRT alone, respectively (p = 0.019). Based on multivariate analysis, receiving adjuvant chemotherapy was independently associated with increased overall survival (p = 0.011; HR 0.658; 95% CI, 0.476 to 0.908). Conclusions: Adjuvant chemotherapy may improve survival in patients with locally advance esophageal cancer who have no evidence of local nodal metastases following surgery. Additional clinical trials are needed to further confirm which patients may benefit from adjuvant therapy and to determine the optimal postoperative therapeutic regimen.

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.

Concomitant Chemotherapy and External Radiotherapy plus Brachytherapy for Locally Advanced Esophageal Cancer Results of a Retrospective Multicenter Study

2005 ◽  
Vol 91 (5) ◽  
pp. 406-414 ◽  
Author(s):  
Maria Tessa ◽  
Paolo Rotta ◽  
Riccardo Ragona ◽  
Barbara Sola ◽  
Mario Grassini ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Local Control ◽  
Locally Advanced ◽  
Survival Rates ◽  
High Dose Rate ◽  
High Dose ◽  
External Radiotherapy ◽  
Advanced Esophageal Cancer ◽  
Locally Advanced Esophageal Cancer

Aims and Background In October 1995, the Piedmont AIRO (Italian Society of Radiation Oncology) Group started a multi-institutional study of radiochemotherapy on locally advanced esophageal cancer, characterized by external radiotherapy followed by an intraluminal high dose-rate brachytherapy boost. Most patients were re-evaluated for surgery at the end of the program. The primary aim of the study was to assess efficacy of curative radiochemotherapy regarding overall survival and local control rates. The secondary aim was to evaluate the ability of radiochemotherapy to make resectable lesions previously considered inoperable. Methods and Study Design Between January 1996 and March 2000, 75 patients with locally advanced esophageal cancer were enrolled. All were treated with definitive radiotherapy; due to age or high expected toxicity, chemotherapy was employed only in 53 of them. Treatment schedule consisted of 60 Gy external radiotherapy (180 cGy/d, 5 days/week for 7 weeks) concomitant with two 5-day cycles of chemotherapy with cisplatin and fluorouracil (weeks 1 and 5). One or two sessions of 5-7 Gy intraluminal high dose-rate brachytherapy were carried out on patients whose restaging showed a major tumor response. Surgery was performed in 14 patients. Results At the end of radiotherapy, dysphagia disappeared in 46/75 cases (61%), and in 20/75 (27%) a significant symptom reduction was recorded. Complete objective response at restaging after radiotherapy was obtained in 33% of patients and a partial response in 53%. At the end of the multimodal treatment program, including esophagectomy, complete responses were 34 (45%); 4 of 14 (28.5%) cases proved to be disease free (pTO) at pathological examination. No G3-G4 toxicity was recorded. Two- and 5-year overall survival rates of all patients were, respectively, 38% and 28%; 2- and 5-year local control rates were, respectively, 35% and 33%. In a subgroup of 20 nonsurgical patients in complete response after radiochemotherapy, the overall survival rate at 3 and 5 years was 65% and the local control rate at 3 and 5 years was 75%. According to multivariate analysis, prognostic factors for survival were Karnofsky index and esophagectomy. Conclusions For patients with locally advanced disease, radiochemotherapy showed improved clinical and pathologic tumor response and survival compared to surgery or radiotherapy alone. Intraluminal brachytherapy with a small fraction size allows an increased dose to the tumor without higher toxicity. Esophagectomy following radiochemotherapy could improve survival rates compared to definitive radiochemotherapy, but it is necessary to optimize selection criteria for surgery at the re-evaluation phase.

Optimal Therapy in Locally Advanced Esophageal Cancer: A National Cancer Database Analysis

2017 ◽  
Vol 152 (5) ◽  
pp. S1220-S1221
Author(s):  
William M. Whited ◽  
Jaimin Trivedi ◽  
Victor van Berkel ◽  
Matthew Fox
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
National Cancer Database ◽  
Advanced Esophageal Cancer ◽  
Database Analysis ◽  
Optimal Therapy ◽  
Locally Advanced Esophageal Cancer

Adjuvant chemotherapy after trimodality therapy in locally advanced esophageal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 144-144
Author(s):  
Divya Yerramilli ◽  
Davendra Sohal ◽  
Ursina R. Teitelbaum ◽  
Paul Stephen Wissel ◽  
Nevena Damjanov ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Adjuvant Chemotherapy ◽  
Clinical Outcomes ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Preoperative Chemoradiation ◽  
Hematologic Toxicity ◽  
Advanced Esophageal Cancer ◽  
Trimodality Therapy ◽  
Locally Advanced Esophageal Cancer

144 Background: The benefit of adjuvant chemotherapy after preoperative chemoradiation and surgery is unclear in patients with locally advanced esophageal cancer. We studied the toxicities and clinical outcomes in patients treated with or without adjuvant chemotherapy (CTX) after trimodality therapy. Methods: Records of patients with T3+ or N+ esophageal cancer who received preoperative chemoradiation followed by surgical resection from 2003-2013 were reviewed. Patients with postoperative deaths or poor performance status within 3 months after surgery were excluded (n = 13). Tolerability and hematologic toxicities of adjuvant CTX were recorded. Clinical outcomes of patients treated with adjuvant CTX were compared with a cohort of patients who received no further therapy (NFT). Results: Of the 81 trimodality patients included in the study, 53 received CTX and 28 received NFT after surgery. Median follow-up time was 23 months. FOLFOX (34%), cisplatin/5-FU (15%), 5-FU/LV (15%), ECF (13%), and carboplatin/paclitaxel (9%) were the most commonly used adjuvant regimens. Multiple rationales for adjuvant CTX were cited, including pathologic nodal status (32%), favorable pathologic response (61%), and provider preference (51%). Grade III/IV hematologic toxicity occurred in 11% of the CTX group: leukopenia (8%/2%), neutropenia (4%/4%), and thrombocytopenia (2%/0%). Two patients in the CTX group did not complete their prescribed CTX, which was discontinued after 1 cycle. Patient and clinical characteristics between CTX and NFT patients were well-balanced, except for pathologic complete response (pCR) rates (CTX 25% vs. NFT 50%, p=0.03). Three-year OS and DFS were similar between CTX and NFT patients (74% vs 70%, 60% vs. 64%, respectively). In patients who achieved pCR (33% overall), adjuvant CTX was associated with an improved 3-yr OS (86% vs. 62%), but the difference did not reach statistical significance (p=0.22). Distant failures occurred in 11% of the CTX group and 18% of the NFT group. Conclusions: Adjuvant CTX after trimodality therapy in esophageal cancer is feasible and well-tolerated with encouraging clinical outcomes. Further studies are needed to define the role of adjuvant CTX in these patients.

Optimal Therapy in Locally Advanced Esophageal Cancer: a National Cancer Database Analysis

2017 ◽  
Vol 22 (2) ◽  
pp. 187-193 ◽  
Author(s):  
William M Whited ◽  
Jaimin R. Trivedi ◽  
Emily R. Bond ◽  
Victor H. van Berkel ◽  
Matthew P. Fox
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
National Cancer Database ◽  
Advanced Esophageal Cancer ◽  
Database Analysis ◽  
Optimal Therapy ◽  
Locally Advanced Esophageal Cancer

Multimodality therapy for locally advanced esophageal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 211-211
Author(s):  
Nitesh N. Paryani ◽  
Stephen Ko ◽  
Corey James Hobbs ◽  
Kristin Kowalchik ◽  
Elizabeth Johnson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Acute Toxicity ◽  
Locally Advanced ◽  
Late Toxicity ◽  
Advanced Esophageal Cancer ◽  
Current Standard ◽  
Grade 3 ◽  
Experienced Grade ◽  
Locally Advanced Esophageal Cancer

211 Background: The current standard of care for locally advanced esophageal cancer includes chemoradiotherapy with or without surgery. Radiation is usually delivered via a 3D technique. IMRT has been utilized in the treatment of multiple tumors and demonstrated similar efficacy while offering the possibility of decreased toxicity. Methods: Thirty-six patients were treated with IMRT and chemotherapy. Twenty-one patients underwent surgical resection. Eleven underwent open surgery and the remainder underwent minimally invasive surgery. Chemotherapy consisted primarily of 5-FU with oxaliplatin or cisplatin. All but two patients received 50.4 Gy; one patient received 41.4 Gy without surgery and one patient discontinued treatment after 25.2 Gy. Eleven patients required a treatment break during radiotherapy. The median age was 69 (range 46-87). Approximately two-thirds of tumors were adenocarcinomas located in the lower thorax. Two thirds of patients were staged as T3 and had positive lymph nodes. The median tumor size was 5 cm (range 2-13). Results: With a median follow-up of 21.3 months (range 2.4-44.8) and 33.9 months for survivors (range 3.7-44.8), overall survival at 24 months was 55%. The 24 month overall survival was 75% vs 24% for surgical and non-surgical patients, respectively. Seven patients had a complete pathologic response. Twenty-four patients experienced grade 3 or higher acute toxicity and there was one grade 5 toxicity. Acute toxicity was similar between surgery and non-surgery patients. Fourteen patients experienced grade 3 or higher late toxicity; 9 surgery and 5 non-surgery patients. The most frequent late toxicity was grade 3 stricture (21%). On multivariate analysis, advanced age (RR [10 year increase] 2.01, p=0.032) and heart maximum dose >55 Gy (RR 3.73, p=0.011) were associated with decreased survival. Conclusions: Patients who undergo surgery after chemoradiotherapy demonstrate improved survival; however, this may be related to underlying comorbidities that preclude surgery. IMRT appears to be a reasonable treatment option that may reduce complications from radiotherapy. Careful attention should be given to heart dose during treatment planning.

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