Long-term outcomes of trimodality treatment for squamous cell carcinoma of the esophagus with cisplatin and/or 5-FU

Fakhrian, Khashayar; Ordu, Arif Deniz; Lordick, Florian; Theisen, Jörg; Haller, Bernhard; Omrčen, Tomislav; Molls, M.; Nieder, Carsten; Geinitz, Hans

doi:10.1007/s00066-014-0711-4

Cited by 18 publications

(13 citation statements)

References 32 publications

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“…The most common cancer-related complication in these patients is dysphagia with an increasing rate as the disease progresses, leading to nutritional compromise, pain, reduced performance status and deterioration of quality of life 3 , 4 . Many of these patients with severe clinical symptoms are not fit enough to undergo surgical resection or curative radiochemotherapy 5 , 6 . The latter approaches are not suitable for patients with distant metastases either 7 .…”

Section: Introductionmentioning

confidence: 99%

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Welsch¹,

Kup²,

Nieder³

et al. 2016

J. Cancer

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Purpose: The aim of this study was to assess the 6-months dysphagia-free survival, improvement in swallowing function, complication rate, and overall survival in patients with incurable esophageal cancer treated with palliative radiotherapy.Methods: We retrospectively reviewed data from 139 patients (median age 72 years) with advanced/recurrent incurable esophageal cancer, who were referred to 3 German radiation oncology centers for palliative radiotherapy between 1994 and 2014. Radiotherapy consisted of external beam radiotherapy (EBRT) with 30 - 40.5 Gy/2.5 - 3 Gy per fraction, brachytherapy alone (BT) with 15 - 25 Gy/5 - 7Gy per fraction/weekly and EBRT + BT (30 - 40.5 Gy plus 10 - 14 Gy with BT) in 65, 46, and 28 patients, respectively. Dysphagia-free survival (Dy-PFS) was defined as the time to worsening of dysphagia for at least one point, a new loco-regional failure or death of any cause.Results: Median follow-up time was 6 months (range 1-6 months). Subjective symptom relief was achieved in 72 % of patients with median response duration of 5 months. The 1-year survival rate was 30%. The 6-months Dy-PFS time for the whole group was 73 ± 4%. The 6-months Dy-PFS was 90 ± 4% after EBRT, 92 ± 5% after EBRT + BT and 37 ± 7% after BT, respectively (p<0.001). Five patients lived for more than 2 years, all of them were treated with EBRT ± BT. Ulceration, fistula and stricture developed in 3, 6 and 7 patients, respectively.Conclusions: Radiotherapy leads to symptom improvement in the majority of patients with advanced incurable esophageal cancer. The present results favor EBRT ± BT over BT alone. Due to the retrospective nature of this study, imbalances in baseline characteristics might have contributed to this finding, and further trials appear necessary.

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Section: Introductionmentioning

confidence: 99%

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Welsch¹,

Kup²,

Nieder³

et al. 2016

J. Cancer

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“…The reasons for refusal of SR for these 53 patients were as follows: (1) patients' or physicians' preference for the planned treatment was changed during the N-RCT, such that RCT was continued to a curative dose without a break (group 1, n = 23, 44%); (2) patients were restaged after 4 weeks, and the tumor board decided to continue RCT because RO resection was unlikely and/or patients were medically unfit (group 2, n = 15, 28%); (3) patients refused continuation of any treatment (group 3, n = 15, 28%). Refusal of SR was significantly more likely in patients with longitudinal tumor dimension >8 cm and those with an Eastern Cooperative Oncology Group performance status score of 2.…”

Section: Resultsmentioning

confidence: 99%

“…

Aims and Background The primary objective was to assess the different reasons for refusal of surgical resection (SR) in patients with esophageal squamous cell cancer (ESCC), who were initially planned for neoadjuvant radiochemotherapy (N-RCT) + SR, but SR was not performed after N-RCT.

Methods and Study Design From 1988 to 2011, 311 patients with ESCC were treated with N-RCT in a tertiary referral center for esophageal diseases. Fifty-three patients were analyzed who received RCT with 40–45 Gy and concomitant chemotherapy in neoadjuvant intention, but in whom the treatment was stopped or switched to definitive RCT due to progression, patient decision, or new findings.

Results The reasons for refusal of SR for these 53 patients were as follows: (1) patients' or physicians' preference for the planned treatment was changed during the N-RCT, such that RCT was continued to a curative dose without a break (group 1, n = 23, 44%); (2) patients were restaged after 4 weeks, and the tumor board decided to continue RCT because RO resection was unlikely and/or patients were medically unfit (group 2, n = 15, 28%); (3) patients refused continuation of any treatment (group 3, n = 15, 28%). Refusal of SR was significantly more likely in patients with longitudinal tumor dimension >8 cm and those with an Eastern Cooperative Oncology Group performance status score of 2.

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confidence: 99%

Outcomes of Patients with Squamous Cell Carcinoma of Esophagus who did not receive Surgical Resection after Neoadjuvant Radiochemotherapy

Fakhrian

Ordu

Nieder

et al. 2015

Tumori

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“…Although several treatment strategies were introduced, surgery is considered the mainstay of ESCC treatments. However, the total outcome was still poor with a ten-year survival rate of less than 15% [25]. This is due to the recurrence of ESCC originating from residual cancer cells.…”

Section: Discussionmentioning

confidence: 99%

Multiphoton microscopy for label-free identification of intramural metastasis in human esophageal squamous cell carcinoma

Xu¹,

Kang²,

Zeng³

et al. 2017

Biomed. Opt. Express

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For complete removal of cancerous tissue in esophageal squamous cell carcinoma (ESCC), intramural metastasis (IM) should be identified preoperatively or intraoperatively. Here, multiphoton microscopy (MPM) was introduced for label-free identification of IM in the esophageal wall, by a combination of two-photon excited fluorescence (TPEF), second harmonic generation (SHG) imaging, and spectral analysis. Three-dimensional (3D) imaging of the IM region was also performed. Quantitative parameters, including 3D fiber orientation, were measured by 3D-weighted orientation vector summation. Overall, MPM showed the potential to identify IM. With the development of the advanced MPM endoscope, clinical identification of IM by MPM will be possible. References and links1. S. Tsutsui, H. Kuwano, M. Watanabe, M. Kitamura, and K. Sugimachi, "Resection margin for squamous cell carcinoma of the esophagus," Ann. Surg. 222(2), 193-202 (1995). 2. N. Yuasa, H. Miyake, T. Yamada, K. Oda, Y. Nimura, T. Nagasaka, and T. Hattori, "Prognostic significance of the location of intramural metastasis in patients with esophageal squamous cell carcinoma," Langenbecks Arch. Surg. 389(2), 122-127 (2004 Memadathil, E. Weyand, M. Holtmann, R. Schirrmacher, M. M. Weber, M. Anlauf, G. Klöppel, M. Vieth, P. R. Galle, P. Bartenstein, M. F. Neurath, and R. Kiesslich, "In-vivo confocal real-time mini-microscopy in animal models of human inflammatory and neoplastic diseases

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Long-term outcomes of trimodality treatment for squamous cell carcinoma of the esophagus with cisplatin and/or 5-FU

Abstract: Higher radiation doses and more use of simultaneous cisplatin lead to higher pathologic response rates to N-RCT and may be associated with better survival outcomes. Prospective controlled trials are needed to assess the true value of intensified N-RCT regimens.

Cited by 18 publications

References 32 publications

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Survival and Symptom Relief after Palliative Radiotherapy for Esophageal Cancer

Outcomes of Patients with Squamous Cell Carcinoma of Esophagus who did not receive Surgical Resection after Neoadjuvant Radiochemotherapy

Multiphoton microscopy for label-free identification of intramural metastasis in human esophageal squamous cell carcinoma

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