Neoadjuvant versus definitive chemoradiation for locally advanced esophageal squamous cell carcinoma

Post, Carl M.; Haefner, Matthias F.; Lin, Chi; Simone, Charles B.; Verma, Vivek

doi:10.21037/tcr.2017.05.26

Cited by 5 publications

(3 citation statements)

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“…Third, the inclusion of T1-2N0 patients (similar to the CROSS study) may bias towards no differences between groups, as patients more likely to benefit from ARTs may be more advanced/bulky cases. Fourth, these results were not performed in the definitive CRT setting and do not apply to this circumstance (36,40). Nevertheless, the caveats herein do not obviate the need for further investigation to corroborate these conclusions.…”

Section: Discussionmentioning

confidence: 78%

Utilization of neoadjuvant intensity-modulated radiation therapy and proton beam therapy for esophageal cancer in the United States

Haque¹,

Verma²,

Butler³

et al. 2018

J. Gastrointest. Oncol.

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Utilization of ARTs (IMRT in the vast majority) is steadily rising in the United States; 3DCRT is now used in a minority of patients. This has implications for payers and insurance coverage. ART use is impacted by not only age and disease factors, but also regional and facility differences. Treatment at an academic facility independently correlated with higher survival, which has implications for patient counseling.

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Section: Discussionmentioning

confidence: 78%

Utilization of neoadjuvant intensity-modulated radiation therapy and proton beam therapy for esophageal cancer in the United States

Haque¹,

Verma²,

Butler³

et al. 2018

J. Gastrointest. Oncol.

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“…Although the value of trimodality therapy in EC has now been more clearly defined, there remains a degree of controversy regarding the more practical point of RT dosing when delivered preoperatively (19). There are numerous findings and reflections from this analysis of a contemporary national database, the largest of its kind to date.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Haque¹,

Verma

Butler³

et al. 2018

J. Gastrointest. Oncol.

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Background: Neoadjuvant chemoradiotherapy (CRT) for locally advanced esophageal cancer (EC) may utilize a wide variety of RT doses, without clear consensus to date. This study evaluated national practice patterns between lower dose (LD) (40-41.4 Gy) or higher dose (HD) (50-50.4 Gy) therapy, in addition to differences in survival and postoperative events. Methods: The National Cancer Data Base (NCDB) was queried [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013] for patients with newlydiagnosed cT1a-T4aN0/N+M0 EC that received neoadjuvant CRT followed by esophagectomy. Conclusions: Although neoadjuvant LD CRT has been underutilized for EC in the United States, it is rising in more recent years. Dose did not significantly impact survival before or after propensity matching, nor did it independently predict for survival. Treatment at academic facilities independently correlated with higher survival, which has implications for patient counseling.

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“…A recent meta-analysis showed that dCRT and surgery are equally effective as initial treatments for resectable esophageal cancer (19). Transhiatal esophagectomy poses significant risks, including tracheal and pulmonary injury, anastomotic leak, vagus nerve injury, infection, and death (20). Currently, based on the finding of a similar outcome in survival in the randomized trials, the approach of dCRT is a reasonable choice especially in patients with ESCC.…”

Section: Discussionmentioning

confidence: 99%

Definitive Radiation Therapy With Dose Escalation Is Beneficial For Patients With Squamous Cell Cancer Of The Esophagus

Ghosh‐Laskar

Mummudi

Kumar

et al. 2020

Preprint

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OBJECTIVE: We report the long term follow up, toxicity, and outcomes of patients with localized squamous cell carcinoma of the esophagus (ESCC) who underwent definitive chemo-radiotherapy (dCRT) at our institute. MATERIALS AND METHODS: Patients diagnosed with carcinoma post cricoid, upper cervical and thoracic oesophagus and treated with dCRT treated between January 2000 and March 2012 were retrospectively analyzed. Data was extracted from the hospital medical records and patient files. Patients deemed inoperable received upfront RT with or without concurrent chemotherapy and patients with borderline resectable and/or bulky disease received neoadjuvant chemotherapy followed by CRT or RT alone. Radiotherapy was delivered in two phases to a maximum dose of 63 Gy in daily fractions of 1.8 Gy using conventional or conformal techniques. Overall survival and progression free survival were defined from date of registration and were calculated by Kaplan Meier method with comparisons between different subgroup performed using log rank test. All data were analyzed using SPSS Version 22. RESULTS: Three hundred and fourteen patients with ESCC treated with dCRT were included in this analysis. Median age at presentation was 56 years and median Karnofsky Performance Status (KPS) at presentation was 70. Two-third of patients were treated with conformal technique alone or a combination of conventional and conformal technique. Median dose of radiation delivered was 60 Gy (range 30.6 Gy to 70 Gy). Neoadjuvant chemotherapy was administered in about 35% patients and 57% patients received concurrent chemotherapy. About 82% patients (77%) completed their planned treatment course; 10% patients required hospitalization during treatment due to complications and 7 patients did not complete treatment. Grade 1/2 dermatitis and mucositis was seen in 77% and 71% patients respectively. Grade 3 nonhematological and hematological toxicities were seen infrequently. Complete response at first follow up was observed in 56% of patients. At a median follow up of 56 months, 77 patients were alive with controlled disease. The 1, 2 and 3yr OS were 80%, 67% and 62% respectively. Median PFS was 28 months; 1, 2 and 3yr PFS were 66%, 52% and 46% respectively. A higher RT dose was found to be a significant predictor for OS and PFS on both uni- and multivariate analysis. CONCLUSION: Our study highlights that delivery of higher RT doses (more than or equal to 63Gy) is feasible in this patient group and that a higher RT dose was associated with significantly better PFS and OS.

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Neoadjuvant versus definitive chemoradiation for locally advanced esophageal squamous cell carcinoma

Cited by 5 publications

References 0 publications

Utilization of neoadjuvant intensity-modulated radiation therapy and proton beam therapy for esophageal cancer in the United States

Utilization of neoadjuvant intensity-modulated radiation therapy and proton beam therapy for esophageal cancer in the United States

Radiation dose in neoadjuvant chemoradiation therapy for esophageal cancer: patterns of care and outcomes from the National Cancer Data Base

Definitive Radiation Therapy With Dose Escalation Is Beneficial For Patients With Squamous Cell Cancer Of The Esophagus

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