Chemoradiotherapy for Synchronous Multiple Primary Cancers with Esophageal Squamous Cell Carcinoma: a Case-control Study

Abstract

Objective: To evaluate the efficacy and toxicity of concurrent chemoradiotherapy (CRT) in multiple primary cancers (MPC) of the upper digestive tract in esophageal squamous cell carcinoma (ESCC).Methods: In a screening of 1193 consecutive patients diagnosed with ESCC and received radiotherapy, 53 patients presenting synchronous MPC in the upper digestive tract were retrospectively investigated. 53 consecutive patients with esophageal non-multiple primary cancer (NPC), matched by stage, age and sex, served as control. All of the patients received concurrent CRT. The median radiation dose was 60 Gy. Chemotherapy regimens were based on platinum and/or 5-fluorouracil. Clinical outcomes and treatment toxicities were compared.Results: Clinic-pathologic characteristics were well balanced between groups. MPC mostly located in esophagus (43, 81.8%), followed by hypopharynx (8, 15.1%) and stomach (2, 3.8%). In MPC and NPC patients, 94.3% and 96.2% completed the intended treatment. The immediate response rate was 73.6% vs 75.5%, with complete response rate of 11.3% vs 24.5% and partial response rate of 62.3% vs 51.0%. Two-year overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS) and distant progression-free survival (DPFS) were 52.2% vs 68.9% (p=0.026), 32.9% vs 54.0% (p=0.032), 60.8% vs 87.8% (p=0.002) and 64.0% vs 70.8% (p=0.22), respectively. Acute grade 3-4 toxicities were observed in 64.2% vs 54.7%, significantly higher in radiation esophagitis (49.1% vs 28.3%, p<0.001), and mucositis (11.3% vs 00p=0.027).Conclusions: Compared with matched NPC, ESCC accompanied with synchronous MPC was related to significantly impaired survival, elevated risk of locoregional disease progression and higher incidence of severe esophagitis and mucositis, following concurrent chemoradiotherapy. Future study on reasons for decreased efficacy of chemoradiotherapy will help to optimize treatment. Advanced radiation techniques may play a role in protecting normal tissues and reduce acute toxicities.

Clinicopathological features and prognosis of patients with esophageal cancer as the second primary cancer: a large population-based analysis using the SEER program [2000–2015]

“…However, patients must be carefully evaluated before the decision for surgery, thus additional research is needed to decide whether to perform operations. In difficult cases, chemoradiotherapy served as an optimal alternative ( 30 ). However, additional research is needed to resolve this important question.…”

Evaluation of the prevalence of metachronous second primary malignancies in hypopharyngeal carcinoma and their effect on outcomes

“…Similarly, Bugter et al 10 from the Netherlands reported that multiple primary tumors develop as frequently in the HN‐region (5.3%) as in the lung (4.9%). Others have observed that the stomach is another prevalent site of metachronous second primary malignancies 3,19 . Regarding the reason behind the organs involved, the HN‐region, esophagus, and lung are all upper aerodigestive tract mucosa and are exposed to similar environmental carcinogens which can be explained by the field cancerization theory 20 …”

Clinical outcomes for 61 cases of hypopharyngeal cancer with synchronous esophageal cancer

“…Although radiotherapy/chemoradiotherapy has been recommended as the first-line treatment for both advanced HPC and EC, the role of radiotherapy/chemoradiotherapy in treating synchronous HPC–EC has not been well-established. Two studies reported the treatment results of chemoradiotherapy on synchronous EC and head and neck (HN) cancer, most of which were HPC [13, 14]. In an earlier study published in 2011, 33 patients received HN and mediastinal radiation.…”