Clinical Results of Definitive-dose (50 Gy/25 Fractions) Preoperative Chemoradiotherapy for Unresectable Esophageal Cancer

Overview

Journal Int J Clin Oncol

Specialty Oncology

Date 2014 Jul 31

PMID 25073955

Citations 7

Authors

Kazuki Ishikawa

Kiyoshi Nakamatsu

Osamu Shiraishi

Takushi Yasuda

Yasumasa Nishimura

Affiliations

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Abstract

Background: The clinical results of definitive-dose preoperative chemoradiotherapy (CRT) of 50 Gy/25 fractions/5 weeks for unresectable esophageal cancer were analyzed.

Methods: Inclusion criteria were unresectable esophageal squamous cell carcinoma with T4b or mediastinal lymph nodes invading to the trachea or aorta. Radiation therapy of 50 Gy/25 fractions/5 weeks was combined concurrently with two courses of FP therapy (CDDP 70 mg/m(2) + 5-FU 700 mg/m(2)/d × 5 days: day 1-5, day 29-33). Tumor response was evaluated 4 weeks after completion of RT. Subtotal esophagectomy was planned 6-8 weeks after RT.

Results: Thirty patients (26 male and 4 female) aged from 50-78 years (median 66) were enrolled between 2008 and 2011. The clinical stages according to the 7th edition of UICC were stages II/III/IV, 1/23/6; T1/2/3/4, 1/1/4/24; and N0/1/2/3, 3/25/1/1. All 30 patients completed RT of 50 Gy/25 fractions. Initial tumor responses were 21 patients with resectable disease, 7 with unresectable disease, and 2 with progressive disease. Subtotal esophagectomy was performed in 18 (60%) of the 30 patients. Pathological complete response was obtained in five (28%) patients. There were two patients with hospitalization death after surgery (11%). Six of the 7 patients who still had unresectable disease were treated with 1-3 courses of docetaxel, CDDP and 5-FU. Three patients treated without surgery showed long-term survival. The 3-year loco-regional control rate and the 3-year overall survival rate for the 30 patients were 70 and 49%, respectively.

Conclusions: Definitive-dose preoperative CRT was feasible, and is a promising treatment strategy for unresectable esophageal cancer.

Citing Articles

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Treatment patterns and survival in T4b esophageal cancer: a retrospective cohort study.

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Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy.

Defize I, van der Horst S, Bulbul M, Haj Mohammad N, Mook S, Meijer G Ann Surg Oncol. 2020; 28(5):2730-2738.

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