scholarly journals A CASE REPORT OF SUCCESSFUL TREATMENT OF STAGE IV ESOPHAGEAL CANCER

2019 ◽  
Vol 18 (4) ◽  
pp. 106-111
Author(s):  
V. N. Khmelevskaya ◽  
P. A. Isaev ◽  
I. V. Gunko
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Stage Iv ◽  
Complete Response ◽  
Esophageal Stenosis ◽  
Advanced Esophageal Cancer ◽  
Cervical Esophageal Cancer ◽  
Scientific Center ◽  
Cervical Lymph Nodes ◽  
Fractionated Radiotherapy

Background. Esophageal cancer is among the ten most common cancers and causes-related mortality worldwide. Most patients present with an advanced stage tumor at diagnosis. To treat patients with esophageal cancer, radiation therapy in combination with chemotherapy is usually used. In the clinic of A.F. Tsyb Medical Radiological Scientific Center, patients with advanced esophageal cancer are treated with split-course radiotherapy delivered in two fractions (1–1.5 Gy) with a 4-hour interval. The positive effect is observed significantly earlier than in conventional radiotherapy.Case description. A 50-year-old male patient presented with complaints of hoarseness of voice and difficulty swallowing in February 2015. The patient was diagnosed with stage cТ4N2M1 cervical esophageal cancer (tumor length 3.5 cm) with metastases in cervical lymph nodes and the thyroid and esophageal stenosis (stage IV). Cytological examination revealed keratinizing squamous cell esophageal carcinoma. The tumor was considered inoperable. The patient underwent gastrostomy. Radiation therapy delivered to the tumor and metastases was performed 5 times a week using two lateral fields and one anterior field. The total radiation dose was 60 Gy. A complete response was achieved. Three courses of chemotherapy with carboplatin (AUC 6), paclitaxel (75 mg/m2 ) with a 21-day interval were administered 2 months after radiotherapy. In January 2016, new metastases in the thyroid were detected. Thyroidectomy with microsurgical neurolysis of the laryngeal nerves was performed. The patient is alive 3 years and 7 months after diagnosis.Conclusion. The use of nonconventional fractionated radiotherapy schedules in combination with chemotherapy allows satisfactory treatment outcomes in patients with advanced esophageal cancer to be obtained. 

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.

scholarly journals Investigative therapy for advanced esophageal cancer using the option for combined immunotherapy and chemotherapy

Immunotherapy ◽  
2020 ◽  
Author(s):  
Huan Wang ◽  
Tian-Tian Xuan ◽  
Ying Chen ◽  
Hui Yu ◽  
Tian-Tian Gu ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Stage Iv ◽  
Esophageal Cancer Patient ◽  
Line Treatment ◽  
Advanced Esophageal Cancer ◽  
First Line ◽  
Combined Immunotherapy ◽  
First Line Treatment

Aim: Advanced esophageal cancer has limited therapeutic options and a poor outcome. The efficacy of immunotherapy, as the first-line treatment of advanced esophageal cancer, is uncertain. Results: A stage IV advanced esophageal cancer patient received the first-line treatment with a combination of pembrolizumab and chemotherapy. Partial response (PR) was achieved after three cycles, and the efficacy was evaluated as stable after six cycles of immunochemotherapy and two cycles of maintenance monotherapy. Immune-related adverse events (irAEs) were not obvious. The patient was followed up till November 2019 when he died of gastrointestinal hemorrhage. Conclusion: The combination of an immune checkpoint inhibitor and chemotherapy is effective and safe for the initial treatment of advanced esophageal cancer. To confirm the evidence from this case, larger clinical trials are required in the future.

Exclusive chemoradiation with carboplatin-paclitaxel versus FOLFOX-4 in locally advanced esophageal cancer: A matched-pair analysis.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 145-145
Author(s):  
Joelle Miny ◽  
Aurelie Bertaut ◽  
Jean Francois Bosset ◽  
Jihane Boustani ◽  
Magali Rouffiac ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Stage Iv ◽  
Matched Pair ◽  
Advanced Esophageal Cancer ◽  
Paired Data ◽  
Group A ◽  
The Cross ◽  
Group B ◽  
Locally Advanced Esophageal Cancer

145 Background: The PRODIGE 5 trial has demonstrated the safety and the efficacy of FOLFOX-4 combined with exclusive 50Gy external RT while the CROSS trial showed an improvement in overall survival with Carboplatin-Taxol (C-TAX) when combined with 41.4Gy before surgery. We sought to determine the feasibility and efficacy of exclusive RT with C-TAX compared to FOLFOX-4 regimen. Methods: 46 patients with locally advanced esophageal cancer who were treated with exclusive chemoradiation were matched 1:1 : 23 patients were treated with FOLFOX-4 regimen (group A) and 23 patients with C-TAX (group B). Comparison between the 2 groups was performed using Mac Nemar test for paired data. All tests were two sided and Pvalues were considered significant when less than 0.05. Results: The mean age in group A was 69.4 years (12.5) and 72.4 years (12.6) in group B (p = ns). In each group, 11 patients had a stage III disease at diagnosis (47.8%) with only 2 stage IV in group A (8.7%) vs none in group B. The median delivered RT doses were 50Gy [14-60] in group A while it was 50Gy [20-70] in group B. 6 courses of chemotherapy were delivered in 12 patients in group A (52.2%) and 14 patients in group B (60.9%) (p = 0.51). After chemoradiation, G1 or higher esophagitis was observed in 5 patients (26.3%) in group A and 3 patients (13.0%) in group B of whom 0 vs 2 G3 were observed in group A and B, respectively. Four patients (21.1%) had a pulmonary infection in group A and 3 in group B (13.0%). Two patients (8.7%) vs 4 patients (17.4%) had G3 neutropenia, with only 0 and 2 neutropenic fever in group A and B, respectively. Neither G3 anemia, nor G3 thrombopenia occured. After a median follow-up of 17.7 months [0.0-46.9], 25 patients had died, 14 in group A (60.9%) and 11 in group B (47.8%). The median PFS rates were 14.0 months in group A [7.7-NR] vs 12.1 months [4.4-NR] in group B (p = 0.32). The median OS rates were 20.3 months in group A [6.2-39.3] vs 17.0 months [4.8-NR] in group B (p = 0.82). Conclusions: Exclusive chemoradiation with C-TAX seems feasible with similar toxicity and survival outcomes than FOLFOX-4. The safety and efficacy of the CROSS regimen needs to be tested prospectively with RT doses > 41.4Gy in a phase II or III trial.

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