Concurrent chemoradiotherapy with S-1 and cisplatin in advanced esophageal cancer

Abstract

How best to manage advanced esophageal cancer remains unresolved, especially in palliative care. Here, in a pilot study, we evaluated the efficacy and safety of concurrent chemoradiotherapy with S-1 and cisplatin in advanced esophageal cancer. Patients with locally advanced or metastatic squamous cell carcinoma of the esophagus received S-1 and cisplatin at doses of 70 mg/m(2)/day for 14 days and 70 mg/m(2) on day 1, respectively, every 3 weeks. Concurrently, radiotherapy was started at a dose of 200 cGy/day, up to a total of 5400 cGy. After concurrent chemoradiotherapy, additive chemotherapy was repeated up to six cycles. Thirty patients were enrolled in this study; of the 27 in whom efficacy could be evaluated, an objective response rate was seen in 20 (74.1%), including five (18.5%) complete pathologic responses in primary lesions. Improvement of dysphagia was seen in 21 (76%) patients. In patients with stage II or III esophageal cancer, the median progression-free survival and overall survival were 10.6 +/- 0.6 months (95% CI: 9.4-11.8) and 23.0 +/- 5.1 months (95% CI: 13.0-32.9), respectively. In patients with stage IV esophageal cancer, the median progression-free survival and overall survival were 5.4 +/- 1.6 months (95% CI: 2.2-8.6) and 11.6 +/- 1.6 months (95% CI: 8.4-14.8), respectively. The main hematological toxicity was neutropenia, but no neutropenic fever was observed. The major non-hematological toxicities were asthenia and vomiting, mostly of grades 1 and 2. Thus, concurrent chemoradiotherapy with S-1 and cisplatin may be a promising nonsurgical treatment in advanced esophageal cancer.

Do all patients with carcinoma of the esophagus benefit from treatment at teaching facilities?

“…This is most likely due in part to molecular advances in understanding the biochemical alterations that occurs with this disease, as well as pharmaceutical advances in chemoradiation as neoadjuvant and adjuvant therapy [33][34][35]. However, primary prevention remains our most powerful weapon.…”

S-1 Monotherapy as Second- or Third-Line Chemotherapy for Unresectable and Recurrent Esophageal Squamous Cell Carcinoma

“…Sudo et al [19 ]reported that radiation, used in combination with S-1, showed promising antitumor activity and acceptable toxicity in the treatment of locally advanced pancreatic cancer. Based on these reports, combination chemotherapy or chemoradiotherapy with S-1 for ESCC should be effective, but there have been few reports of such combination therapy [20,21,22], and further studies are needed.…”

Phase I study of concurrent selective lymph node late-course accelerated hyperfractionated radiotherapy and S-1 plus cisplatin for locally advanced oesophageal squamous cell carcinoma

“…On the basis of several clinical trial reports of S-1, together with other cytotoxic agents, locally advanced and metastatic EC, the maximum dose of S-1 was set at 80 mg m 22 twice daily. [19][20][21] The dose level just below the MTD was defined as the RD for further Phase II study. As soon as the RD was determined, additional five patients were required to further evaluate the safety of RD.…”

“…However, the toxicities were still somewhat higher. Recently, CCRT using oral fluoropyrimidine (S-1) and CDDP for the treatment of advanced EC was investigated [19][20][21] , but data on the S-1 used in concurrent LCAF RT in EC are limited. To further decrease the side effects and to improve outcomes, we designed this Phase I trial of CCRT for patients with locally advanced ESCC.…”