Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus

Wong, Rebecca; Malthaner, Richard

doi:10.1002/14651858.cd002092.pub2

Cited by 87 publications

(60 citation statements)

References 58 publications

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“…Our study, involving an inoperable patient cohort, yielded similar results to those of other prospective studies [12,13] and a meta-analysis of randomized trials [14], which evaluated combined chemoradiotherapy versus radiotherapy alone in patients with localized esophageal carcinoma.…”

Section: Discussionsupporting

confidence: 80%

Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case-control study

Sgourakis

Gockel²,

Karaliotas

et al. 2012

BMC Cancer

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BackgroundOur aim was to compare survival of the various treatment modality groups of chemotherapy and/or radiotherapy in relation to SEMS (self-expanding metal stents) in a retrospective case-control study. We have made the hypothesis that the administration of combined chemoradiotherapy improves survival in inoperable esophageal cancer patients.MethodsAll patients were confirmed histologically as having surgically non- resectable esophageal carcinoma. Included were patients with squamous cell carcinoma, undifferentiated carcinoma as well as Siewert type I--but not type II - esophagogastric junctional adenocarcinoma. The decision to proceed with palliative treatments was taken within the context of a multidisciplinary team meeting and full expert review based on patient's wish, co-morbid disease, clinical metastases, distant metastases, M1 nodal metastases, T4-tumor airway, aorta, main stem bronchi, cardiac invasion, and peritoneal disease. Patients not fit enough to tolerate a radical course of definitive chemo- and/or radiation therapy were referred for self-expanding metal stent insertion. Our approach to deal with potential confounders was to match subjects according to their clinical characteristics (contraindications for surgery) and tumor stage according to diagnostic work-up in four groups: SEMS group (A), Chemotherapy group (B), Radiotherapy group (C), and Chemoradiotherapy group (D).ResultsEsophagectomy was contraindicated in 155 (35.5%) out of 437 patients presenting with esophageal cancer to the Department of General and Abdominal Surgery of the University Hospital of Mainz, Germany, between November 1997 and November 2007. There were 133 males and 22 females with a median age of 64.3 (43-88) years. Out of 155 patients, 123 were assigned to four groups: SEMS group (A) n = 26, Chemotherapy group (B) n = 12, Radiotherapy group (C) n = 23 and Chemoradiotherapy group (D) n = 62. Mean patient survival for the 4 groups was as follows: Group A: 6.92 ± 8.4 months; Group B: 7.75 ± 6.6 months; Group C: 8.56 ± 9.5 months, and Group D: 13.53 ± 14.7 months. Significant differences in overall survival were associated with tumor histology (P = 0.027), tumor localization (P = 0.019), and type of therapy (P = 0.005), respectively, in univariate analysis. Treatment modality (P = 0.043) was the only independent predictor of survival in multivariate analysis. The difference in overall survival between Group A and Group D was highly significant (P < 0.01) and in favor of Group D. As concerns Group D versus Group B and Group D versus Group C there was a trend towards a difference in overall survival in favor of Group D (P = 0.069 and P = 0.059, respectively).ConclusionsThe prognosis of inoperable esophageal cancer seems to be highly dependent on the suitability of the induction of patient-specific therapeutic measures and is significantly better, when chemoradiotherapy is applied.

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Section: Discussionsupporting

confidence: 80%

Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case-control study

Sgourakis

Gockel²,

Karaliotas

et al. 2012

BMC Cancer

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“…A greater proportion (16–54 per cent) initially showed a response but locoregional disease was discovered later (arbitrarily defined as more than 3 months after completion of treatment). Conclusions based on this classification should be considered with caution because whether a tumour is classified as persistent or recurrent may depend to some extent on the quality of the investigations in the early stages of follow‐up13. A proportion of patients were referred to oesophagogastric surgeons for consideration of salvage surgery after the failure of CRT became apparent ( Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…There is growing enthusiasm for this approach because these survival figures are comparable with the results of surgery12. Although long‐term survival is the primary goal, local control and freedom from dysphagia are important secondary endpoints for any treatment for oesophageal cancer13. Patients treated using CRT alone require dilatation or stents for palliation of strictures or local recurrence more often than those treated by surgery9.…”

Section: Introductionmentioning

confidence: 99%

Salvage oesophagectomy after local failure of definitive chemoradiotherapy

Gardner-Thorpe

Hardwick

Dwerryhouse

2007

British Journal of Surgery

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“…However, no such data have been shown for a non-selected patient cohort. Of special notice in this regard is the fact that most patients in the Munich setting have received mitomycin-C [13] instead of cisplatin which was used in most of the randomized trials [7,8,14,33]. Interestingly, the addition of chemotherapy only increases local control and was never found to reduce the high rate of loco-regional and distant seeding.…”

Section: Discussionmentioning

confidence: 99%

“…The introduction of radio-chemotherapy protocols, regardless of the use of platinum, offer a clear advantage when compared to radiotherapy alone [7,13,14]. …”

Section: Introductionmentioning

confidence: 99%

Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

et al. 2012

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Background and objectivesTreatment options for oesophageal cancer have changed considerably over the last decades with the introduction of multimodal treatment concepts dominating the progress in the field. However, it remains unclear in how far the documented scientific progress influenced and changed the daily routine practice. Since most patients with oesophageal cancer generally suffer from reduced overall health conditions it is uncertain how high the proportion of aggressive treatments is and whether outcomes are improved substantially. In order to gain insight into this we performed a retrospective analysis of patients treated at a larger tertiary referral centre over time course of 25 years.Patients and methodsData of all patients diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the oesophagus, treated between 1983 and 2007 in the department of radiation oncology of the LMU, were obtained. The primary endpoint of the data collection was overall survival (calculated from the date of diagnosis until death or last follow up). Changes in basic clinical characteristics, treatment approach and the effect on survival were analysed after dividing the cohort into five subsequent time periods (I-V) with 5 years each. In a second analysis any pattern of change regarding the use of radio(chemo)therapy (R(C)T) with and without surgery was determined.ResultsIn total, 503 patients with SCC (78.5%) and AC (18.9%) of the oesophagus were identified. The average age was 60 years (range 35-91 years). 56.5% of the patients were diagnose with advanced UICC stages III-IV. R(C)T was applied to 353 (70.2%) patients; R(C)T+ surgery was performed in 134 (26.6%) patients, 63.8% of all received chemotherapy (platinum-based 5.8%, 5-fluorouracil (5-FU)12.1%, 42.3% 5-FU and mitomycin C (MMC)). The median follow-up period was 4.3 years. The median overall survival was 21.4 months. Over the time, patients were older, the formal tumour stage was more advanced, the incidence of AC was higher and the intensified treatment had a higher prevalence. However there was only a trend for an improved OS over the years with no difference between RCT with or without surgery (p = 0.09). The use of radiation doses over 54 Gy and the addition of chemotherapy (p = 0.002) were associated with improved OS.ConclusionAlthough more complex treatment protocols were introduced into clinical routine, only a minor progress in OS rates was detectable. Main predictors of outcome in this cohort was the addition of chemotherapy. The addition of surgery to radio-chemotherapy may only be of value for very limited patient groups.

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Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus

Cited by 87 publications

References 58 publications

Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case-control study

Survival after chemotherapy and/or radiotherapy versus self-expanding metal stent insertion in the setting of inoperable esophageal cancer: a case-control study

Salvage oesophagectomy after local failure of definitive chemoradiotherapy

Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

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