Prospective randomised study of split-course radiotherapy versus cisplatin plus split-course radiotherapy in inoperable squamous cell carcinoma of the oesophagus

Wobbes, Th.; Baron, B.; Paillot, B; Jacob, Jacques-Henri; P, Haegele; Gignoux, M; Michel, Pierre; Couvreur, M.L.

doi:10.1016/s0959-8049(00)00399-3

Cited by 42 publications

(17 citation statements)

References 11 publications

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“…Although two studies [1,2] with 59 and 70 patients, respectively, were too small to achieve statistically significant results, both studies show a trend towards superiority of RCT. The 3 other studies with more patients [3][4][5] show superior results of concurrent RCT in their median survival times as well as in the 2-or 5-year survival rate. Unfortunately, the EORTC study [5] used a high single dose of 4 Gy, so that its results can only be utilised with reservations.…”

Section: Definitive Radiochemotherapymentioning

confidence: 99%

“…The 3 other studies with more patients [3][4][5] show superior results of concurrent RCT in their median survival times as well as in the 2-or 5-year survival rate. Unfortunately, the EORTC study [5] used a high single dose of 4 Gy, so that its results can only be utilised with reservations. The Eastern Cooperative Oncology Group [3] applied 5-fluorouracil (5-FU)/mitomycin C and irradiation simultaneously.…”

Section: Definitive Radiochemotherapymentioning

confidence: 99%

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Definitive and Neoadjuvant Radiochemotherapy of Squamous Cell Carcinoma of the Oesophagus

Fietkau

2004

Oncol Res Treat

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In cases of advanced carcinoma of the oesophagus with no metastatic spread, a concurrent radiochemotherapy can improve the patient’s prognosis in comparison to radiotherapy alone. This approach increases the treatmentrelated toxicity, in particular haematological side effects. Therefore therapy must be adapted to the general condition of the patient, demanding an intensive supportive treatment and monitoring of the patient. At present the optimal radiation dose and the role of brachytherapy for the reduction of the still high rate of local recurrences has not been determined. The value of neoadjuvant radiochemotherapy for operable or inoperable tumours is unclear. Meta-analyses did show an improvement of the prognosis, however most of the randomised studies found improvement only for the recurrence rate but not for survival. The reasons for this are numerous; however, the high postoperative lethality after radiochemotherapy in some studies is conspicuous. Conversely, the initial results of randomised studies show that operative measures could possibly be forgone if a complete remission is achieved by concurrent radiochemotherapy. Nevertheless, this approach must also be regarded critically, as the local recurrence rate after radiochemotherapy alone is high and long-term results are not available.

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Section: Definitive Radiochemotherapymentioning

confidence: 99%

Section: Definitive Radiochemotherapymentioning

confidence: 99%

Definitive and Neoadjuvant Radiochemotherapy of Squamous Cell Carcinoma of the Oesophagus

Fietkau

2004

Oncol Res Treat

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“…The success of chemoradiation has led to debate about the contribution of this surgery and discussion attempting to define those patients most likely to derive curative benefit from resection. Older clinical trials using concurrent chemoradiation alone have resulted in outcomes which are similar to those achieved in multimodality trials including surgery [13,14] . Two randomized trials have directly compared chemoradiotherapy alone to chemoradiotherapy followed by surgery, and both studies failed to show an improved survival with the surgery.…”

Section: Introductionmentioning

confidence: 87%

Predictive value of restaging after induction concurrent chemoradiotherapy for locoregionally advanced adenocarcinoma of the esophagus and gastroesophageal junction

Phillips

Adelstein

Rice

et al. 2012

JST

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Background: Current treatment protocols for locoregionally advanced esophageal cancer add concurrent chemoradiotherapy to surgical resection in an effort to improve curative potential. These approaches are intensive and toxic. This retrospective review was undertaken to identify clinical features after concurrent chemoradiotherapy that might predict for treatment failure.Methods: 155 patients with locoregionally advanced adenocarcinoma of the esophagus/gastroesophageal junction were treated with concurrent chemoradiation with 96 hour infusions of cisplatin (20mg/m 2 /day) and fluorouracil(1,000mg/m 2 /day) beginning on day 1 of radiation (30 Gy @ 1.5 Gy bid). Surgery followed in 4-6 weeks with identical concurrent chemotherapy planned post-operatively. 75 patients also received 2 years of oral gefitinib Pretreatment staging evaluation was obtained in all patients which included a medical history, physical examination, complete blood count, serum chemistries, chest radiograph, computed tomographic scans of the chest and abdomen, pulmonary function studies, esophagogastroduodenoscopy (EGD) with biopsy, endoscopic ultrasound (EUS), and bronchoscopy if indicated by symptomatology, or by the extent or location of the primary lesion. This also included assessment of symptomatic dysphagia. Approximately 3 weeks after completing induction chemoradiation, all patients underwent restaging evaluation. Using this pretreatment and posttreatment staging information, prognostic factors for freedom from recurrence and overall survival were identified. Results:The 36 months freedom from recurrence was 31% and overall survival 32%. Post-induction change in EGD tumor length and EUS TNM stage did not correlate with outcome. Resolution of symptomatic dysphagia, which occurred in 86%, was the strongest predictor for freedom from recurrence (p<0.001) and overall survival (p<0.001).Conclusions: EGD and EUS restaging of locoregional disease after induction concurrent chemoradiotherapy did not help to predict recurrence. The persistence symptomatic dysphagia, when coupled with advanced pretreatment stage, is ominous and predicts for incurable disease. Subsequent therapy should be considered palliative.

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“…67 The benefits of surgery in FFCD 9102 might have been confounded by some methodological issues. 69 The overall lower dose of chemotherapy for patients receiving resection, the use of split radiation course, which may result in worse survival rates than conventional radiotherapy, 70 and the high surgical mortality 25,71 may have negatively impacted OS outcome. Therefore, the benefit of surgery after CRT is still an open question and may need a modern day trial using modern techniques to convincingly answer this question.…”

Section: Neoadjuvant Crt Vs Definitive Crt For Locally Advanced Esophmentioning

confidence: 99%

Esophageal cancer: comparative effectiveness of treatment options

Cai¹,

Lin²

2016

CER

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Esophageal cancer is a lethal disease. Multimodal therapy has improved the survival and local control for locally advanced esophageal cancer compared to surgery alone. Neoadjuvant chemoradiotherapy (CRT) plus surgery is the accepted standard of care for operable esophageal cancer. Pathologic complete response is very common, ranging from 18% to 43%, and it is an independent favorable prognostic factor for survival. Salvage surgery after definitive CRT may be safe and feasible for patients with esophageal cancer who achieve pathologic complete response after neoadjuvant CRT. For inoperable cases, definitive CRT is an alternative treatment modality. Intensity-modulated radiation therapy may reduce treatment-related toxicities due to its better dose homogeneity and conformity compared to three-dimensional conformal radiotherapy. Proton therapy can further improve target conformity and normal tissue sparing when compared to photon therapy (three-dimensional conformal radiotherapy and intensitymodulated radiation therapy) and, therefore, likely to further improve the treatment outcomes of patients. This article compares the effectiveness of the various treatment approaches in the definitive or neoadjuvant setting and reviews the evidence on the benefit of utilizing advanced radiation techniques for the curative management of esophageal cancer.

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Prospective randomised study of split-course radiotherapy versus cisplatin plus split-course radiotherapy in inoperable squamous cell carcinoma of the oesophagus

Cited by 42 publications

References 11 publications

Definitive and Neoadjuvant Radiochemotherapy of Squamous Cell Carcinoma of the Oesophagus

Definitive and Neoadjuvant Radiochemotherapy of Squamous Cell Carcinoma of the Oesophagus

Predictive value of restaging after induction concurrent chemoradiotherapy for locoregionally advanced adenocarcinoma of the esophagus and gastroesophageal junction

Esophageal cancer: comparative effectiveness of treatment options

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