Definitive chemoradiotherapy

Ståhl, Michael; Budach, Wilfried

doi:10.21037/jtd.2017.05.05

Cited by 14 publications

(12 citation statements)

References 38 publications

(35 reference statements)

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“…However, despite multimodality treatment with dCRT, substantial patients still succumb to distant recurrences [6][7][8]20], which thereby warrants the need to explore more aggressive treatments. In theory, the addition of induction chemotherapy potentially imparts beneficial effects due to early elimination of micrometastasis, enhancement of sensitivity to the subsequent CRT, and allowance for enough time for careful radiotherapy planning [29][30][31]. Several prospective, single arm trials have investigated the feasibility of induction chemotherapy preceding dCRT for ESCC.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lymph Node-To-Primary Tumor Standardized Uptake Value Ratio in Esophageal Squamous Cell Carcinoma Treated with Definitive Chemoradiotherapy

Lin

Hung

Chang

et al. 2020

Cancers

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We aimed to investigate the prognostic value of the relative maximum standardized uptake value (SUV) of metastatic lymph node (LN) compared with that of primary tumor (SUVLN/SUVTumor) based on a pretreatment [18F]-FDG PET/CT scan in patients with clinically node-positive esophageal squamous cell carcinoma (cN+ ESCC) treated with definitive chemoradiotherapy (dCRT). We retrospectively evaluated cN+ ESCC patients who underwent a PET/CT scan before dCRT. Time-dependent receiver operating characteristics analysis was performed to identify the optimal cutoff value for SUVLN/SUVTumor. Prognostic influences of SUVLN/SUVTumor on distant metastasis-free survival (DMFS) and overall survival (OS) were evaluated using the Kaplan–Meier method and log-rank test for univariate analysis and Cox’s proportional hazards regression model for multivariate analysis. We identified 112 patients with newly diagnosed cN+ ESCC. After a median follow-up of 32.0 months, 50 (44.6%) patients had distant failure and 84 (75.0%) patients died. Patients with high SUVLN/SUVTumor (≥ 0.39) experienced worse outcomes than low SUVLN/SUVTumor (< 0.39) (two-year DMFS: 26% vs. 70%, p < 0.001; two-year OS: 21% vs. 48%, p = 0.001). Multivariate analysis showed that SUVLN/SUVTumor was an independent prognostic factor for both DMFS (adjusted HR 2.24, 95% CI 1.34–3.75, p = 0.002) and OS (adjusted HR 1.61, 95% CI 1.03–2.53, p = 0.037). Pretreatment of SUVLN/SUVTumor is a simple and useful marker for prognosticating DMFS and OS in cN+ ESCC patients treated with dCRT, which may help in tailoring treatment and designing future clinical trials.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Lymph Node-To-Primary Tumor Standardized Uptake Value Ratio in Esophageal Squamous Cell Carcinoma Treated with Definitive Chemoradiotherapy

Lin

Hung

Chang

et al. 2020

Cancers

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“…Recent reports reveal a fundamental controversy about the further treatment strategy for patients with tumor remission/regression after neoRCT. Some authors claim that remission/ regression might be a strong indicator for performing surgery whereas others report it as an indicator for dose escalation and the continuation of RCT without surgery [13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant and Definitive Radiochemotherapeutic Approaches in Esophageal Cancer: A Retrospective Evaluation of 122 Cases in Daily Clinical Routine

et al. 2020

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Introduction: Esophageal cancer (EC) is a common malignant tumor entity with increasing occurrence. The incidence of esophageal adenocarcinoma (AC), particularly, is constantly rising in the Western world. The mainstays of therapy with curative intent for EC in advanced stages are neoadjuvant radiochemotherapy (neoRCT) with surgery and definitive radiochemotherapy (defRCT). Methods: We examined our internal files to identify patients suffering from EC. Palliative cases were excluded. Statistical testing was performed by χ 2 test, Student's t test, Kaplan-Meier analyses, and the Mann-Whitney U test. Results: One hundred and twentytwo cases were included. Histology revealed squamous cell carcinoma in 92 cases and AC in 23 cases. Ninety-five patients underwent defRCT, 27 underwent neoRCT, and 114 (in both therapy regimes) received simultaneous chemotherapy. There was no difference in the overall survival (OS) (p = 0.654; HR 1.145; 95% CI 0.629-2.086) or and progression-free survival (PFS) (p = 0.912) of patients who underwent neoRCT or defRCT. Median OS was 13.5 (2-197) months for defRCT patients and 19.5 (2-134) months for neoRCT patients (p = 0.751). Karnofsky index (KI) with a cutoff of 70% was strongest, but not a significant parameter for OS (p = 0.608) or PFS (p = 0.137). Conclusion: defRCT is a valid and an equal alternative to neoRCT for patients suffering from EC. Selection of patients for therapy is of crucial relevance. Further studies and improvements in follow-up are needed when neoRCT has been completed before surgery, in order to spare the patient undergoing operative treatment if there is complete remission. The identification of valid markers urgently needed to limit treatment side effects.

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“…In this study, neoadjuvant CRT with curative intent consisted of 5 cycles of carboplatin (area under the curve 2 mg/ml/min)/paclitaxel 50 mg/m 2 and 41.4 Gy/1.8 Gy or occasionally 50.4 Gy/1.8 Gy radiotherapy followed by potentially curative surgery, based on the CROSS regimen 1,18. Definitive or primary CRT usually included concurrent chemotherapy (cisplatin/5-FU or carboplatin/paclitaxel) and radiotherapy > 50.4 Gy/1.8–2 Gy as first treatment in patients who were unable to undergo surgical resection 19,20. In the analysis, patients with primary intended nCRT of 41.4–50.4 Gy/1.8 Gy in whom additional surgical resection was denied because of deteriorated medical condition and potentially high risk for severe morbidity and mortality.…”

Section: Methodsmentioning

confidence: 99%

Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

et al. 2019

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Purpose This study was designed to assess the impact of age and comorbidity on choice and outcome of definitive chemoradiotherapy (dCRT) or neoadjuvant chemoradiotherapy plus surgery. Methods In this population-based study, all patients with potentially curable EC (cT1N+/cT2-3, TX, any cN, cM0) diagnosed in the South East of the Netherlands between 2004 and 2014 were included. Kaplan–Meier method with log-rank tests and multivariable Cox regression analysis were used to compare overall survival (OS). Results A total of 702 patients was included. Age ≥ 75 years and multiple comorbidities were associated with a higher probability for dCRT (odds ratio [OR] 8.58; 95% confidence interval [CI] 4.72–15.58; and OR 3.09; 95% CI 1.93–4.93). The strongest associations were found for the combination of hypertension plus diabetes (OR 3.80; 95% CI 1.97–7.32) and the combination of cardiovascular with pulmonary comorbidity (OR 3.18; 95% CI 1.57–6.46). Patients with EC who underwent dCRT had a poorer prognosis than those who underwent nCRT plus surgery, irrespective of age, number, and type of comorbidities. In contrast, for patients with squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, OS was comparable between both groups (hazard ratio [HR] 1.52; 95% CI 0.78–2.97; and HR 0.73; 95% CI 0.13–4.14). Conclusions Histological tumor type should be acknowledged in treatment choices for patients with esophageal cancer. Neoadjuvant chemoradiotherapy plus surgery should basically be advised as treatment of choice for operable esophageal adenocarcinoma patients. For patients with esophageal squamous cell carcinoma with ≥ 2 comorbidities or age ≥ 75 years, dCRT may be the preferred strategy.

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Definitive chemoradiotherapy

Cited by 14 publications

References 38 publications

Prognostic Value of Lymph Node-To-Primary Tumor Standardized Uptake Value Ratio in Esophageal Squamous Cell Carcinoma Treated with Definitive Chemoradiotherapy

Prognostic Value of Lymph Node-To-Primary Tumor Standardized Uptake Value Ratio in Esophageal Squamous Cell Carcinoma Treated with Definitive Chemoradiotherapy

Neoadjuvant and Definitive Radiochemotherapeutic Approaches in Esophageal Cancer: A Retrospective Evaluation of 122 Cases in Daily Clinical Routine

Impact of Age and Comorbidity on Choice and Outcome of Two Different Treatment Options for Patients with Potentially Curable Esophageal Cancer

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