Chemoradiotherapy of Locally Advanced Esophageal Cancer

Cooper, Jay S.; Guo, Matthew; Herskovic, Arnold; Macdonald, John S.; Martenson, James A.; Al‐Sarraf, Muhyi; Byhardt, Roger W.; Russell, Anthony H.; Beitler, Jonathan J.; Spencer, Sharon A.; Asbell, Sucha O.; Graham, Mary V.; Leichman, Lawrence

doi:10.1001/jama.281.17.1623

Cited by 1,629 publications

(537 citation statements)

References 17 publications

(13 reference statements)

Supporting

Mentioning

506

Contrasting

Unclassified

Order By: Relevance

“…Of the 34 patients enrolled in our study, 31 (91.2%) patients completed preplanned CCRT, including 27 (79.4%) patients who received full dose of chemotherapy. The full dose of chemotherapy completion rate in this study was much higher than in the RTOG 85‐01 trial, in which all cycles of chemotherapy could be administered as planned in 33 of 61 (54%) patients 3. The completion rate in our study was in line with other recent clinical trials.…”

Section: Discussionsupporting

confidence: 87%

“…The median OS in this study was 23.7 months, which was better when compared with the 14.1 month median OS in the CCRT group of the RTOG 85‐01 trial 3 and the 13 month median OS in high‐dose group of the RTOG 94‐05 trial 18 . The survival outcomes in our study were also comparable to latest results from other clinical trials in the CCRT setting with modern chemotherapy regimens.…”

Section: Discussioncontrasting

confidence: 48%

“…In terms of late toxicities, we noted two (5.9%) patients experienced grade 3 esophageal stenosis and five patients got grade 1–2 pneumonitis. The late toxicities were also lower than that observed in RTOG 85‐01, in which 21.3% patients in the CCRT arm experienced late esophageal morbidity 3. In general, our treatment regimen was well tolerated.…”

Section: Discussionmentioning

confidence: 53%

“…Although esophagectomy is the optimal treatment option, a majority of patients are not suitable for resection at the time of presentation for locally advanced or metastatic disease and a large proportion of patients need receive radiotherapy 2. The Radiation Therapy Oncology Group (RTOG) 85–01 trial assessed the efficacy of definitive radiotherapy of 50.4 Gy plus concurrent chemotherapy with 5‐fluorouracil (5‐Fu) and cisplatin (CDDP) in patients with locally advanced esophageal cancer, which led to a long‐term survival rate of approximately 25%, which is similar to patients treated with surgery alone 3. This trial established definitive concurrent chemoradiotherapy (CCRT) as a standard treatment for locally advanced esophageal cancer patients who do not want surgery or are inappropriate for surgery as a result of technical or medical reasons.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Long‐term results of definitive concurrent chemoradiotherapy using paclitaxel plus oxaliplatin in unresectable locally advanced esophageal cancer: a prospective phase II trial

et al. 2016

View full text Add to dashboard Cite

This prospective study aimed at assessing the efficiency and safety of concurrent chemoradiotherapy (CCRT) using paclitaxel (PTX) plus oxaliplatin (OHP) in unresectable locally advanced esophageal cancer patients. Between January 2006 and December 2010, 34 patients with unresectable locally advanced esophageal cancer were enrolled in this study. Radiotherapy was delivered with a daily fraction of 2.0 Gy to a total dose of 60 Gy over 6 weeks. Concurrent PTX (135 mg/m², d 1) and OHP (130 mg/m², d 1) were administered on Day 1 and Day 29 of radiotherapy. Of these patients, 76.5% completed the treatment course with a response rate of 73.5%, including eight (23.5%) patients with complete response and 17 (50.0%) patients with partial response. The median overall survival (OS) time was 23.7 months (range: 4.0–65.5 months) with 1‐, 3‐ and 5‐year OS rates were 64.3%, 36.6% and 25.8%, respectively. The median progression‐free survival (PFS) time was 21.2 months with 1‐, 3‐ and 5‐year PFS rates were 63.8%, 30.9% and 20.4%, respectively, During the CCRT course, the main grade 3 or greater acute toxicities were leukopenia (38.2%), esophagitis (14.7%), and dysphagia (11.8%), with late toxicity being infrequent. Although this study did not meet its primary endpoint, the application of CCRT with PTX and OHP in unresectable locally advanced esophageal carcinoma yielded satisfactory clinical outcomes and manageable toxicities.

show abstract

Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long‐term results of definitive concurrent chemoradiotherapy using paclitaxel plus oxaliplatin in unresectable locally advanced esophageal cancer: a prospective phase II trial

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The recurrence pattern among the patients with no evidence of remaining malignancy after treatment showed a high proportion of distant disease where more radical locoregional therapy such as more extensive surgery or radiotherapy alone (20)(21)(22). This picture of a survival bene t is less clear in the randomized studies where preoperative chemoradiation is compared with surgery alone.…”

Section: Discussionmentioning

confidence: 99%

A Swedish Study of Chemoradiation in Squamous Cell Carcinoma of the Esophagus

et al. 2001

View full text Add to dashboard Cite

Bias and Trials Stopped Early for Benefit

Korn¹,

Freidlin²,

Mooney³

2010

JAMA

View full text Add to dashboard Cite

However, the notable findings in the study by Talcott et al 1 and the earlier report by Zietman et al 2 were that (1) at 5 years, a significantly higher proportion of men remained free of biochemical failure in the higher-dose radiation group (80.4%) vs the conventional-dose treatment group (61.4%) and that (2) at a median of 9.4 years following treatment, there were no significant differences in key functional parameters between conventional-dose and high-dose treatment, such as urinary obstruction, urinary incontinence, bowel problems, and decreased sexual function. Furthermore, at a median follow-up time of 8.9 years, long-term cancer control was still significantly higher in the highdose vs conventional-dose treatment groups. 3 We suspect that these findings about symptoms probably were not necessarily only "because eventually the patients will adapt and stop complaining" (as Vikram suggests), but instead may represent important and meaningful outcomes for patients. Similarly, Talcott et al also found that patients who had received conventional doses were significantly more concerned about control of their cancer than patients who had received high doses, and also tended to express more regret.The quality-of-life consequences for men treated for prostate cancer and the psychological toll experienced by men concerned with disease recurrence should not be underestimated. The results from the study by Talcott et al add to the evidence that physicians can use when discussing treatment options for men with early prostate cancer by showing that high-dose radiation treatment is not associated with worse long-term adverse effects than conventional-dose treatment.

show abstract

Chemoradiotherapy of Locally Advanced Esophageal Cancer

Abstract: Combined therapy increases the survival of patients who have squamous cell or adenocarcinoma of the esophagus, T1-3 N0-1 M0, compared with RT alone.

Cited by 1,629 publications

References 17 publications

Long‐term results of definitive concurrent chemoradiotherapy using paclitaxel plus oxaliplatin in unresectable locally advanced esophageal cancer: a prospective phase II trial

Long‐term results of definitive concurrent chemoradiotherapy using paclitaxel plus oxaliplatin in unresectable locally advanced esophageal cancer: a prospective phase II trial

A Swedish Study of Chemoradiation in Squamous Cell Carcinoma of the Esophagus

Bias and Trials Stopped Early for Benefit

Contact Info

Product

Resources

About