A randomised trial of radiotherapy compared with cisplatin chemo-radiotherapy in patients with unresectable squamous cell cancer of the esophagus

Kumar, Shaleen; Dimri, Kislay; Khurana, Rohini; Rastogi, Neeraj; Das, K.J. Maria; Lal, Punita

doi:10.1016/j.radonc.2007.03.013

Cited by 55 publications

(45 citation statements)

References 25 publications

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“…In another in vitro experiment with 2 cell lines, a 2-hour post radiation drug exposure resulted in a supra-additive combined effect, whereas a 24-hour preirradiation exposure or protracted postirradiation exposure yielded an additive or slightly subadditive response (Gorodetsky et al, 1998). Mounting evidence from randomized trials in esophageal, nasopharyngeal and uterine cervical cancers in the favour of weekly CDDP based CT-RT has encouraged investigators to use a similar approach in LAHNC (Rose et al, 1999;Chan et al, 2005;Kumar et al, 2007). Most trials have used weekly CDDP either at 40 mg/m 2 (Geeta et al, 2006;Steinmann et al, 2009;Otty et al, 2011;Homma et al, 2011;Pala et al, 2012) or 30 mg/m 2 (Gupta et al, 2009;Watkins et al, 2010;Krstevska et al, 2012) concurrent with 66-70 Gy of conventional external RT.…”

Section: Discussionmentioning

confidence: 99%

“…CDDP in moderate doses (30-40 mg/m 2 ) has also been used in a weekly schedule concurrently with RT, mostly on an out-patient basis. Phase II and randomised trials in oesophageal, nasopharyngeal and cervical cancers have shown it to be well tolerated and efficacious (Rose et al, 1999;Chan et al, 2005;Kumar et al, 2007). Taking a cue from the available data on this approach and our own experience with regime, we used it for the treatment of LAHNC and present an audit of the same.…”

Section: Introductionmentioning

confidence: 99%

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Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Dimri¹,

Pandey²,

Trehan³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Platinum based concurrent chemo-radiation is the de-facto standard of care in the non-surgical management of locally-advanced head and neck cancer of squamous origin. Three-weekly single agent cisplatin at 100 mg/m 2 concurrent with radical radiotherapy has demonstrated consistent improvement in loco-regional control and survival. This improvement is however at the cost of considerable hematologic toxicity and poor overall compliance. The routine use of this regime is improbable in developing countries with limited resources. We therefore aimed to determine the safety and efficacy of an alternative regime of weekly cisplatin and concurrent radiotherapy in such patients. Materials and Methods: January-05 and April-12, 188 patients of locally-advanced head and neck cancer of squamous origin were treated with concurrent weekly-cisplatin at 35mg/m 2 and conventional radiotherapy 60-66Gy/30-33 fractions/5days per week. Results: Overall, 95% patients received planned doses of RT while 74% completed within the stipulated overall treatment time of <50 days. Eighty-two percent received at-least 5 weekly cycles. Grade-III/IV mucositis was seen in 58%/9% respectively, which resulted in mean weight loss of 9.2% from a pre-treatment mean of 54.5 kg. Grade-III hematologic toxicity-0.5%; grade II nephrotoxicity-2.5% and grade III emesis-3% were also seen. Grade-III/IV subcutaneous toxicity-10%/1% and grade-III/IV xerostomia-10%/0% were observed. Complete responses at the primary site, regional nodes and overall disease were seen in 86%, 89% and 83% patients respectively. The median and 5-years disease-free survival were 26 months and 39.4% respectively, while the median and overall survival were 27 months and 41.8% respectively. Conclusions: Weekly-cisplatin at 35 mg /m2 when delivered concurrently with conventional radical RT (at-least 66y/33 fractions) in locally-advanced head and neck cancer is well tolerated with minimal hematologic and neprologic toxicity and can be routinely delivered on an out-patient basis. It is an effective alternative to the standard 3-weekly cisplatin especially in the context of developing countries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Dimri¹,

Pandey²,

Trehan³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Tumor involvement of the trachea or aorta or lung can lead to fistula formation during or after radiotherapy. In regard to brachytherapy, combination chemoradiotherapy with HDR brachytherapy was associated with a high risk of life-threatening toxicities including esophageal ulcer, fistula, and perforation [33,[73][74][75]. And intubation with metallic stents before or during radiotherapy was associated with a high risk of life-threatening complications (grade 3-5, 51 %, grade 5, 21 %) such as hematemesis, esophageal fistula, and pneumonitis [76].…”

Section: Toxicity Of Radiotherapymentioning

confidence: 99%

Radiation Therapy

Ito¹

2014

Esophageal Squamous Cell Carcinoma

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Radiotherapy is indicated for the treatment of esophageal cancer both with curative intent and with palliative intent. Concurrent chemoradiotherapy is the standard treatment for patients in good condition who can receive chemotherapy, based on the result of randomized trial that compared chemoradiotherapy with radiotherapy alone. For locally advanced unresectable esophageal cancer, definitive chemoradiotherapy is the standard therapy with potentially curative intent. And for resectable esophageal cancer, definitive chemoradiotherapy is a treatment option in an attempt to preserve the esophagus from favorable results of clinical trials. These results are supported by salvage treatment in cases of residual or recurrent disease after chemoradiotherapy. However high mortality rate of salvage surgery and high incidence of late toxicities after chemoradiotherapy with higher radiation dose are important problems to be solved. Neoadjuvant chemoradiotherapy is standard treatment for locally advanced esophageal cancer in Western countries; however it is investigational in Japan. Combination chemotherapy of new agents and new radiotherapy technique such as intensity-modulated radiation therapy, protonbeam therapy, and heavy-particle radiotherapy have been evaluated in clinical trials to improve the treatment results including efficacy and toxicity.

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“…Although the treatment of this disease continues to evolve, a growing consensus has emerged advocating multimodality over single-modality therapy for locally advanced esophageal cancer largely based upon the survival advantage seen in multiple randomized trials [2][3][4][5][6][7]. The trials utilizing radiotherapy used a variety of planning modalities, broadly including two-dimensional planning (2DP) and three-dimensional computed tomography-based radiotherapy planning (3DCTP).…”

mentioning

confidence: 99%

“…The trials utilizing radiotherapy used a variety of planning modalities, broadly including two-dimensional planning (2DP) and three-dimensional computed tomography-based radiotherapy planning (3DCTP). The increased toxicity of concurrent chemotherapy with radiation [5,7] has prompted various strategies to decrease toxicity, including the use of 3DCTP. Although 3DCTP is now widely used in the multimodality treatment of locally advanced esophageal cancer, there is little literature in support of this as an effective means to reduce toxicity without compromising efficacy.…”

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confidence: 99%

Choice of Radiotherapy Planning Modality Influences Toxicity in the Treatment of Locally Advanced Esophageal Cancer

Mackley

Adelstein

Reddy

et al. 2008

J Gastrointest Canc

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A randomised trial of radiotherapy compared with cisplatin chemo-radiotherapy in patients with unresectable squamous cell cancer of the esophagus

Cited by 55 publications

References 25 publications

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Radiation Therapy

Choice of Radiotherapy Planning Modality Influences Toxicity in the Treatment of Locally Advanced Esophageal Cancer

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