Accelerated Hyperfractionated Radiation Therapy and Concurrent 5-Fluorouracil/Cisplatin Chemotherapy for Locoregional Squamous Cell Carcinoma of the Thoracic Esophagus: A Phase II Study

Jeremić, Branislav; Shibamoto, Yuta; Aćimović, Ljubiša; Matović, Zoran D.; Miličić, Biljana; Milisavljević, Slobodan; Nikolic, Nebojsa

doi:10.1016/s0360-3016(97)00950-4

Cited by 38 publications

(17 citation statements)

References 23 publications

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“…In our study, this regimen showed a promising activity with a response rate of 50%. However, the median survival time (6 months) and 1-year survival rate (35%) attained in the present study are lower than those of previous studies of cisplatin/5-FUbased chemoradiotherapy[8][9][10][11]17]. In contrast with our study, these trials focused on patients with a good prognosis, and patients with invasion of the tracheobronchial tree and/or significant medical illnesses were excluded.…”

contrasting

confidence: 81%

Weekly docetaxel with concomitant radiotherapy in patients with inoperable oesophageal cancer

et al. 2007

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contrasting

confidence: 81%

Weekly docetaxel with concomitant radiotherapy in patients with inoperable oesophageal cancer

et al. 2007

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“…Despite nutritional surveillance and supervision, radiochemotherapy consisting of a 40.8-Gy accelerated radiation dose and 5-fluorouracil and cisplatinum may adversely affect the patient’s ability to withstand a subsequent thoracoabdominal operation. The rationales to administer accelerated hyperfractionated radiation therapy were suggestions from other studies of a better response rate and long-term prognosis following such a therapy [17, 18, 19, 20]. Warnings, however, have during the later years been raised concerning the toxicity, and, therefore, a relatively modest radiation dose was given [21, 22, 23].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Adjuvant Radiochemotherapy May Increase the Risk in Patients Undergoing Thoracoabdominal Esophageal Resections

Liedman

Johnsson²,

Merke³

et al. 2001

Dig Surg

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Background/Aim: Fatigue and malaise are common symptoms after radiochemotherapy which could affect patients’ working capacity and add to the subsequent postoperative risk. The aim of the study was to investigate whether neoadjuvant radiochemotherapy in patients scheduled for a thoracoabdominal resection impairs their working capacity and adds to the postoperative risk. Patients and Methods: 29 patients with resectable tumors (T₃ or N₁) and a working capacity of ≧80 W on a bicycle test were included into the study. The tumor stage was determined by endoscopic ultrasound and computed tomography scan. The patients were given neoadjuvant radiochemotherapy during 38 days, consisting of two cycles of 5-fluorouracil (1,000 mg/m²) daily during 5 days and cisplatinum (100 mg/m²) on two occasions. Accelerated radiochemotherapy to a total dose of 40.8 Gy was given. Surgery was planned 4–6 weeks after completion of therapy. The patients had a bicycle test before induction of neoadjuvant treatment and 2–5 days prior to the operation. Results: Three patients died already during the course of neoadjuvant treatment. The 26 remaining patients who had a bicycle test decreased their working capacity by a mean of 30 W (p < 0.0001). Ten patients had a decrease of their working capacity to ≤90 W, of whom 6 died within 3 months postoperatively, and of the patients who had the working capacity decreased to ≤80 W, 4 out of 5 died during the corresponding postoperative period. None of the patients, who performed >100 W at the second preoperative bicycle test died. Conclusions: Preoperative adjuvant radiochemotherapy, according to the present schedule, clearly exerts a detrimental effect on the patients’ working capacity. A physical performance, at the time of the operation, ≤80–90 W strongly predicts the subsequent postoperative risk. Similar adjuvant therapies may, therefore, in fact be harmful to some patients scheduled for a thoracoabdominal resection.

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“…13 Other trials with accelerated or hyperfractionation radiation methods also showed no benefit in local control or survival, whereas there were significantly higher incidences of severe esophagitis. [41][42][43] These results showed the limitations of intensifying the radiation dose. The addition of new agents, other than 5-FU plus cisplatin, may be more promising.…”

Section: Future Perspectives In Chemoradiotherapymentioning

confidence: 90%

“…The current standard radiation dose in definitive chemoradiotherapy is 50 Gy, which seems not significantly different from the doses used preoperatively (40)(41)(42)(43)(44)(45). Some small studies have shown the feasibility and efficacy of salvage surgery.…”

Section: Salvage Treatment After Failure Of Definitive Chemoradiotherapymentioning

confidence: 99%

Chemoradiotherapy for esophageal cancer: current status and perspectives

Ohtsu

2004

Int J Clin Oncol

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The optimal role of chemoradiotherapy in the multimodality treatment of esophageal cancer is still controversial. According to a series of clinical trials, definitive chemoradiotherapy is considered the standard of care for patients with medically inoperable or surgically unresectable esophageal cancer. This modality provides survivals comparable to those in Western series of surgery alone and is one of the standards of care even for resectable-stage disease. Recent reports of primary chemoradiotherapy from Japan suggest survival comparable to that of surgery in Japanese patients with stage I disease, but radical surgery is still the standard treatment for T2-3NanyM0 disease in Japan. However, it is clear that this approach has limitations in treatment outcomes. Trimodality therapy, i.e., preoperative chemoradiotherapy followed by surgery, is more favored than surgery alone in clinical practice, particularly in patients with adenocarcinoma, although current data from randomized trials are insufficient to support this approach. To improve the local control rate of chemoradiotherapy, intensification of the radiation dose has been attempted, but this has failed to demonstrate any superiority in terms of local control or survival. The addition of new agents, including molecular targeting agents, to the current standard chemoradiotherapy has shown more promising results and warrants further investigations in future studies. Salvage treatment for patients who do not achieve a complete response (CR) is necessary to improve the overall treatment results. Salvage surgery, as well as endoscopic resection, in selected patients, may provide an improvement in survival. Until high rates of local control can be consistently achieved with chemoradiotherapy alone, these salvage treatments will be an integral component of multimodality treatment for esophageal cancer, and should be active areas for clinical investigations.

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Accelerated Hyperfractionated Radiation Therapy and Concurrent 5-Fluorouracil/Cisplatin Chemotherapy for Locoregional Squamous Cell Carcinoma of the Thoracic Esophagus: A Phase II Study

Cited by 38 publications

References 23 publications

Weekly docetaxel with concomitant radiotherapy in patients with inoperable oesophageal cancer

Weekly docetaxel with concomitant radiotherapy in patients with inoperable oesophageal cancer

Preoperative Adjuvant Radiochemotherapy May Increase the Risk in Patients Undergoing Thoracoabdominal Esophageal Resections

Chemoradiotherapy for esophageal cancer: current status and perspectives

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