Hypofractionated Radiotherapy in Combination With Chemotherapy Improves Outcome of Patients With Esophageal Carcinoma Tracheoesophageal Groove Lymph Node Metastasis

Wang, Jian; Yu, Jingping; Jiang, Yinghua; Dong, Pei; Zhu, Honglin; Wang, Jianlin

doi:10.3389/fonc.2020.01540

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…There are studies demonstrating a survival benefit of this approach particularly in the context of metastatic nodal disease. In one such study, hypofractionated radiotherapy (HFR) administered with taxane based chemotherapy in the management of post-surgery tracheoesophageal groove lymph node (TGLN) metastasis demonstrated improved OS in the HFR group compared with that of the conventional dosing treatment arm [24.1 mo (95%CI, 16.2-32.1 mo) vs 11.9 mo (95%CI, 9.2-14.4 mo), P = 0.024)[ 28 ]. Importantly, the study did not find a significant difference in pulmonary complications such as radiation pneumonitis (grades 3-4, 16.0% vs 7.1%; P = 0.314)[ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of radiotherapy on the immune landscape in oesophageal adenocarcinoma

Donlon¹,

Davern²,

O’Connell³

et al. 2022

WJG

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BACKGROUND In the contemporary era of cancer immunotherapy, an abundance of clinical and translational studies have reported radiotherapy (RT) and immunotherapies as a viable option for immunomodulation of many cancer subtypes, with many related clinical trials ongoing. In locally advanced disease, chemotherapy or chemoradiotherapy followed by surgical excision of the tumour remain the principal treatment strategy in oesophageal adenocarcinoma (OAC), however, the use of the host immune system to improve anti-tumour immunity is rapidly garnering increased support in the curative setting. AIM To immunophenotype OAC patients’ immune checkpoint (IC) expression with and without radiation and evaluate the effects of checkpoint blockade on cell viability. METHODS In the contemporary era of cancer immunotherapy, an abundance of studies have demonstrated that combination RT and IC inhibitors (ICIs) are effective in the immunomodulation of many cancer subtypes, with many related clinical trials ongoing. Although surgical excision and elimination of tumour cells by chemotherapy or chemoradiotherapy remains the gold standard approach in OAC, the propagation of anti-tumour immune responses is rapidly garnering increased support in the curative setting. The aim of this body of work was to immunophenotype OAC patients’ IC expression with and without radiation and to establish the impact of checkpoint blockade on cell viability. This study was a hybrid combination of in vitro and ex vivo models. Quantification of serum immune proteins was performed by enzyme-linked immunosorbent assay. Flow cytometry staining was performed to evaluate IC expression for in vitro OAC cell lines and ex vivo OAC biopsies. Cell viability in the presence of radiation with and without IC blockade was assessed by a cell counting kit-8 assay. RESULTS We identified that conventional dosing and hypofractionated approaches resulted in increased IC expression (PD-1, PD-L1, TIM3, TIGIT) in vitro and ex vivo in OAC. There were two distinct subcohorts with one demonstrating significant upregulation of ICs and the contrary in the other cohort. Increasing IC expression post RT was associated with a more aggressive tumour phenotype and adverse features of tumour biology. The use of anti-PD-1 and anti-PD-L1 immunotherapies in combination with radiation resulted in a significant and synergistic reduction in viability of both radiosensitive and radioresistant OAC cells in vitro. Interleukin-21 (IL-21) and IL-31 significantly increased, with a concomitant reduction in IL-23 as a consequence of 4 Gray radiation. Similarly, radiation induced an anti-angiogenic tumour milieu with reduced expression of vascular endothelial growth factor-A, basic fibroblast growth factor, Flt-1 and pl...

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Section: Discussionmentioning

confidence: 99%

Impact of radiotherapy on the immune landscape in oesophageal adenocarcinoma

Donlon¹,

Davern²,

O’Connell³

et al. 2022

WJG

View full text Add to dashboard Cite

show abstract

“…The efficiency and safety of hypofractionated radiotherapy (HFR) combined with paclitaxel chemotherapy for the treatment of post surgery tracheoesophageal groove lymph node (TGLN) metastasis in patients with esophageal cancer were investigated by Jian Wang et al ( Wang et al, 2020 ). They found that the combination of hypofractionated radiotherapy (HFR) and chemotherapy improved the prognosis of esophageal cancer patients with tracheoesophageal groove lymph node (TGLN) metastasis with no increased adverse events.…”

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confidence: 99%

Editorial: Chemo-Radiation-Resistance in Cancer Therapy

2022

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Pathologic response evaluation of localized or locally advanced esophageal carcinoma to induction chemotherapy followed by preoperative concurrent chemotherapy and hypofractionated radiotherapy: a clinical trial

Emadi Torghabeh,

Aledavood,

Soltani

et al. 2024

Front. Oncol.

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ObjectiveEsophageal cancer is a therapeutic challenge in most healthcare systems. Most patients present with locally advanced disease at diagnosis. Concurrent chemoradiotherapy (CRT) is the standard treatment for locally advanced esophageal carcinoma. Since achieving a complete pathological response in postoperative specimens following neoadjuvant therapy is associated with improved patient survival, this study was designed to evaluate the pathologic response of localized or locally advanced esophageal carcinoma to induction chemotherapy followed by preoperative concurrent chemotherapy and hypofractionated radiotherapy (HFR).MethodsThis single-arm clinical trial (IRCT20210623051676N1) evaluated patients with squamous cell carcinoma or adenocarcinoma of the esophagus, stage cT2-T4a N0 M0 or cT1-T4a N+ M0. Patients received 3-5 cycles of weekly induction chemotherapy with the paclitaxel (50 mg/m2) and carboplatin (AUC=2) regimen, followed by weekly concurrent CRT with the same chemotherapy regimen. The radiation dose was 40 Gy, delivered over 16 fractions, 5 days per week (2.5 Gray/fraction). Patients underwent surgery 4-6 weeks after completion of CRT. The surgical specimens were evaluated for pathological response. A p-value of < 0.05 was considered significant in all analyses.ResultsOut of 54 patients enrolled in this study, 45 completed the neoadjuvant protocol. Of these 45 patients, 32 underwent surgery and were finally analyzed. The mean age of the patients was 59.9 ± 8.6 years (range, 37-75 years). The location of the tumor was in the mid-thoracic esophagus in most patients (21, 65.6%) and the most common histological type was SCC (29, 90.6%). The median number of induction and concurrent chemotherapy cycles was 5 (4.8 ± 1.3 course, range, 1-10) and 3 (2.6 ± 0.8 course, range, 0-4), respectively. Among 45 patients who completed the neoadjuvant protocol, the most common toxicities were grade 3 neutropenia (15.6%), acute renal failure (4.4%), and odynophagia (37.8%). Nearly two-thirds of the patients experienced complete or near-complete responses (71.9%, 23 patients). Partial response was reported in 6 patients (18.8%) and poor response in 3 patients (9.4%).ConclusionPreoperative induction chemotherapy followed by HFR with concurrent chemotherapy has low toxicity and side effects, good tolerance, and significant efficacy in the treatment of patients with esophageal cancer.Clinical trial registrationhttps://irct.behdasht.gov.ir/trial/59930, identifier NCT05745545.

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Hypofractionated Radiotherapy in Combination With Chemotherapy Improves Outcome of Patients With Esophageal Carcinoma Tracheoesophageal Groove Lymph Node Metastasis

Cited by 3 publications

References 24 publications

Impact of radiotherapy on the immune landscape in oesophageal adenocarcinoma

Impact of radiotherapy on the immune landscape in oesophageal adenocarcinoma

Editorial: Chemo-Radiation-Resistance in Cancer Therapy

Pathologic response evaluation of localized or locally advanced esophageal carcinoma to induction chemotherapy followed by preoperative concurrent chemotherapy and hypofractionated radiotherapy: a clinical trial

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