A clinical trial of neoadjuvant concurrent chemoradiotherapy followed by resection for esophageal carcinoma

Abstract

Background:Esophageal carcinoma is a common malignancy in the North East of Iran. Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in the patients with locally advanced esophageal carcinoma.Materials and Methods:Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy and chemotherapy and 3-4 weeks later, esophagectomy. Pathologic response, overall survival rate, toxicity, and feasibility were evaluated.Results:One hundred ninety-seven patients with a median age of 59 (range: 27-70) entered the protocol. One hundred ninety-four cases (98.5%) had esophageal squamous cell carcinoma. Grades 3-4 of toxicity in patients undergoing neoadjuvant chemoradotherapy were as follows: Neutropenia in 21% and esophagitis in 2.5% of cases. There were 11 (5.6%) early death probably due to the treatment-related toxicities. One hundred twenty-seven patients underwent surgery with postsurgical mortality of 11%. In these cases, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 48.2% and median overall survival of 44 months (95% confidence interval, 24.46-63.54).Conclusion:The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the treatment toxicities were relatively high.

The prevalence and expression pattern of melanoma-associated antigen 1 in esophageal squamous cell carcinoma: a historical cohort study

“…They had all undergone neoadjuvant chemoradiation (CRT) in a prospective clinical phase II trial, described by Anvari et al (2). In their study, 197 patients with stage Ib-IIIc esophageal SCC were recruited, 127 patients completed treatment, fourteen patients died due to surgical complications and two patients died of other causes.…”

“…This was a cross-sectional study conducted on pretreatment endoscopic tissue specimens of 43 patients with non-metastatic esophageal SCC, admitted to Omid Hospital, Mashhad University of Medical Sciences, Mashhad, Iran, between 2011 and 2013. They had all undergone neoadjuvant chemoradiation (CRT) in a prospective clinical phase II trial, described by Anvari et al ( 2 ). In their study, 197 patients with stage Ib-IIIc esophageal SCC were recruited, 127 patients completed treatment, fourteen patients died due to surgical complications and two patients died of other causes.…”

The cost-effectiveness of neoadjuvant chemotherapy in women with locally advanced breast cancer: Adriamycin and cyclophosphamide in comparison with paclitaxel and gemcitabine

“…About 60% of those cases believed to occur in the less developed countries. [ 2 3 4 5 ] Globally, the number of deaths from cancer in 2020 will reach about 11.8 million people. [ 2 ] In Iran, cancer is the third main cause of death following cardiovascular diseases and accidents.…”

“…[ 2 ] In Iran, cancer is the third main cause of death following cardiovascular diseases and accidents. [ 3 4 ] The cost of cancer treatment has a high economic burden on the national health system budget. For example, in 2000, in England, 10% of the total spending on healthcare was for cancer treatment.…”

Essential role of Na+/Ca2+ exchanger 1 in smoking-induced growth and migration of esophageal squamous cell carcinoma

“…Esophageal squamous cell carcinoma (ESCC), accounting for about 80% of esophageal cancer, is notoriously aggressive in nature and spreads by a variety of pathways, including direct extension, lymphatic spread and hematogenous metastasis [ 4 – 6 ]. Since ESCC is characterized by poor survival rates and resistance to radiochemotherapy [ 7 – 9 ], novel therapeutic strategies are required urgently to treat this devastating disease. Although the detailed pathogenesis of ESCC is currently unclear, it has been generally accepted that ESCC results from an interaction between the genetic and environmental factors [ 1 , 10 ], and the excessive use of tobacco is strongly considered one of the principal factors in the etiology of ESCC.…”