Definitive chemoradiation in patients with inoperable oesophageal carcinoma

Abstract

We performed a retrospective study of 90 consecutive cases with inoperable carcinoma of the oesophagus treated with definitive chemoradiation at a single cancer centre between 1995 and 2002. For the last 4 years, 73 patients have received therapy according to an agreed protocol. This outpatient-based regimen involves four cycles of chemotherapy, cycles 3 and 4 given concurrently with 50 Gy external beam radiotherapy (XRT) delivered in 25 fractions over 5 weeks. Cisplatin 60 mg m À2 day À1 is given every 3 weeks together with continuous infusional 5-fluorouracil 300 mg m À2 day À1 , reduced to 225 mg m À2 day À1 during the XRT. In all, 45 (50%) patients suffered one or more WHO grade 3/4 toxicity, grade 3 in 93% cases. Patients received more than 90% of the planned chemoradiation schedule. The median overall survival was 26 (15, 496) months, 51% (41, 64) and 26% (13, 52) surviving 2 and 5 years, respectively. Advanced stage, particularly T4 disease, was associated with a worse prognosis. Patients considered not suitable for surgery for reasons other than their disease, mainly co-morbidity, had a significantly better outcome, median survival 40 (26, 496) months, 2-and 5-year survivals 67% (54, 84) and 32% (13, 79), respectively (Po0.001). This schedule is a feasible, tolerable and effective treatment for patients with oesophageal cancer considered unsuitable for surgery.

Shifting Practice in Definitive Chemoradiation for Localized Esophageal Cancer

“…The median os duration for dcrt with cisplatin-5fu reported in phase iii trials ranged from 14 to 18 months 7,20,21 . We observed a median os duration of 28 months in the cisplatin-5fu group, which is similar to the 25-26 months reported in more recent literature 15,22,23 . Known prognostic factors such as performance status, tumour length, clinical stage, histology, and age were considered in the multivariate model that confirmed the association of a survival benefit with cisplatin-5fu 16,24 .…”

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

“…Seven 10,11,[18][19][20][21][22] out of 8 studies used 5-FU plus CDDP; at standard-doses (5-FU 300-700 mg/m 2 , CDDP 40-60 mg/m 2 ) in 4 studies, 10,18,19,21) low-dose CRT (5-FU 200-500 mg/m 2 , CDDP 3-10 mg/m 2 ) in two studies, 11,22) and both in one study. 20) Recently, Font et al 17) used weekly docetaxel regimen (20 mg/m 2 ).…”

“…9) Thus, two modalities are currently in use for the treatment of esophageal tumors 10,11) ; chemo-radiotherapy followed by surgery (CRT-S) [10][11][12][13][14][15][16] and definitive chemo-radiotherapy (D-CRT). [17][18][19][20][21][22] To the best of our knowledge, there is little or no information on the differences in clinical outcome of patients with T4 esophageal tumors who undergo D-CRT and those who receive CRT-S. In this review, we discuss these two treatment modalities.…”

The SCOPE of definitive chemoradiotherapy in locally advanced esophageal cancer: what direction for the future?

“…shrinkage of the tumour before radiotherapy (6,9). However to our best knowledge, this sequence has not been tested in randomized phase III trials versus definitive chemoradiation first which is still the standard of care for non-surgical candidates.…”

“…However all tests for heterogeneity with regard to treatment effect, including the histologic type and the anatomic subsite of the tumor did not reveal any significant heterogeneity. The feasibility of concurrent CRT with capecitabine and cisplatin for patients with esophageal carcinoma was evaluated in small phase II in single-centre series (9,11).…”