Long-term bresults of radiotherapy combined with nedaplatin and 5-fluorouracil for postoperative loco-regional recurrent esophageal cancer: update on a phase II study

Abstract

BackgroundIn 2006, we reported the effectiveness of chemoradiotherapy for postoperative recurrent esophageal cancer with a median observation period of 18 months. The purpose of the present study was to update the results of radiotherapy combined with nedaplatin and 5-fluorouracil (5-FU) for postoperative loco-regional recurrent esophageal cancer.MethodsBetween 2000 and 2004, we performed a phase II study on treatment of postoperative loco-regional recurrent esophageal cancer with radiotherapy (60 Gy/30 fractions/6 weeks) combined with chemotherapy consisting of two cycles of nedaplatin (70 mg/m2/2 h) and 5-FU (500 mg/m2/24 h for 5 days).The primary endpoint was overall survival rate, and the secondary endpoints were progression-free survival rate, irradiated-field control rate and chronic toxicity.ResultsA total of 30 patients were enrolled in this study. The regimen was completed in 76.7% of the patients. The median observation period for survivors was 72.0 months. The 5-year overall survival rate was 27.0% with a median survival period of 21.0 months. The 5-year progression-free survival rate and irradiated-field control rate were 25.1% and 71.5%, respectively. Grade 3 or higher late toxicity was observed in only one patient. Two long-term survivors had gastric tube cancer more than 5 years after chemoradiotherapy.Pretreatment performance status, pattern of recurrence (worse for patients with anastomotic recurrence) and number of recurrent lesions (worse for patients with multiple recurrent lesions) were statistically significant prognostic factors for overall survival.ConclusionsRadiotherapy combined with nedaplatin and 5-FU is a safe and effective salvage treatment for postoperative loco-regional recurrent esophageal cancer. However, the prognosis of patients with multiple regional recurrence or anastomotic recurrence is very poor.

Prognostic Factors for Post-Recurrence Survival in Patients with Thoracic Esophageal Squamous Cell Carcinoma after Curative Resection

“…Moreover, accumulating experience with multimodality therapies has made it possible to safely perform such treatments in patients with recurrence. Recent advances in anticancer drugs and radiation techniques may also help to achieve a good clinical course [1][2][3][4] . Moreover, aggressive surgical resection for recurrent tumors has been reported to contribute to improving a poor…”

Risk Factors for Local Recurrence and Optimal Length of Esophagectomy in Esophageal Squamous Cell Carcinoma

“…Local recurrence worsens the quality of life because of dysphagia and demonstrates poorer prognosis than the recurrences in other sites. Several studies reported LR is a poor prognostic factor for survival in patients with recurrence [8,9]. The survival after radiation therapy for LR is poor, ranging from 7 to 21 months [5,10].…”

Nedaplatin: a cisplatin derivative in cancer chemotherapy

“…There was no significant difference between the two groups. Jingu et al reported on the efficacy and safety of radiotherapy (60 Gy/30 fractions over six weeks) combined with two cycles of combination chemotherapy comprising 5-fluorouracil 500 mg/m 2 per 24 hours for five days and nedaplatin 70 mg/m 2 on day 1 every 3 weeks for 30 patients with postoperative locoregional recurrence of esophageal cancer 34. The rate of completion of this treatment without reduction of chemotherapy was 76.7%.…”