Outcome of Patients Receiving Radiation for Cancer of the Esophagus: Results of the 1992-1994 Patterns of Care Study

Coia, Lawrence R.; Minsky, Bruce D.; Berkey, Brian; John, Madhu; Landry, Jerome C.; Pisansky, Thomas M.; Willett, Christopher G.; Hoffman, John P.; Owen, Jean B.; Hanks, Gerald E.

doi:10.1200/jco.2000.18.3.455

Cited by 142 publications

(114 citation statements)

References 16 publications

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“…Most patients present with stage III or IV disease. Chemoradiation is the standard nonsurgical treatment for patients with locally advanced oesophageal cancer (Coia et al, 2000). Almost 50% of patients treated with standard therapy with continuous infusion 5-FU, cisplatin, and …”

Section: Discussionmentioning

confidence: 99%

Combined modality chemoradiation in elderly oesophageal cancer patients

et al. 2007

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We present a single institution experience with 5-FU, mitomycin-C based chemoradiation for the primary treatment of elderly patients with oesophageal cancer. Twenty-five patients with a median age of 77 years (range 66 -88) with a diagnosis of stage II -III squamous cell or adenocarcinoma of the oesophagus were treated at Memorial Sloan Kettering from 1996 to 2001 with two cycles of concurrent 5-FU, mitomycin-C and 50.4 Gy. Owing to age and comorbidity, these patients were not considered surgical candidates. The Charlson comorbidity score was used to evaluate patient comorbidity. Nine patients (36%) experienced grade 3 -4 haematologic toxicity. Of the 23 patients evaluable for response, 17 patients (68%) had a negative post-treatment endoscopy and CT scan without evidence of progressive disease. Eleven patients (44%) are alive and 10 (40%) remain without evidence of recurrent or progressive oesophageal cancer at a median follow-up of 35 months. The median overall survival was 35 months and 2-year survival 64%. There was no significant difference in overall survival between Charlson score p2 and those with a score X2 (P ¼ 0.10). Similar survival was observed for patients with adenocarcinoma or squamous carcinoma. Primary chemoradiation with two cycles of 5-FU, mitomycin-C, and 50.4 Gy in elderly patients is an active regimen with moderate toxicity, despite the advanced age and heavy comorbidity burden of this cohort. Patients with local/regional oesophageal cancer with adequate functional status should not be excluded from potentially curative treatment based on age alone.

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Section: Discussionmentioning

confidence: 99%

Combined modality chemoradiation in elderly oesophageal cancer patients

et al. 2007

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“…In the United States, results from the 'Patterns of Care' report reflect that chemoradiation is already a standard treatment option for patients with nonmetastatic disease (Coia et al, 2000). In all, 45% of the patients received CRT as their sole therapy, and in 32.8% this was with a RT dose of X50 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite better staging and improving perioperative care, the outcome from this treatment remains poor, with 30 -45% patients surviving 2 years after radical resection (Kelsen et al, 1998;Medical Research Council Oesophageal Cancer Working Group, 2002). The proportion of patients for whom this treatment is selected varies in different countries from 25 to 45% (Fok et al, 1994;Coia et al, 2000;Pye et al, 2001). This complex surgery is challenging for both the surgeon and the patient; between 5 and 10% will die as a result of an oesophagectomy and 30 -40% will suffer significant postoperative morbidity.…”

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confidence: 99%

Definitive chemoradiation in patients with inoperable oesophageal carcinoma

et al. 2004

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We performed a retrospective study of 90 consecutive cases with inoperable carcinoma of the oesophagus treated with definitive chemoradiation at a single cancer centre between 1995 and 2002. For the last 4 years, 73 patients have received therapy according to an agreed protocol. This outpatient-based regimen involves four cycles of chemotherapy, cycles 3 and 4 given concurrently with 50 Gy external beam radiotherapy (XRT) delivered in 25 fractions over 5 weeks. Cisplatin 60 mg m À2 day À1 is given every 3 weeks together with continuous infusional 5-fluorouracil 300 mg m À2 day À1 , reduced to 225 mg m À2 day À1 during the XRT. In all, 45 (50%) patients suffered one or more WHO grade 3/4 toxicity, grade 3 in 93% cases. Patients received more than 90% of the planned chemoradiation schedule. The median overall survival was 26 (15, 496) months, 51% (41, 64) and 26% (13, 52) surviving 2 and 5 years, respectively. Advanced stage, particularly T4 disease, was associated with a worse prognosis. Patients considered not suitable for surgery for reasons other than their disease, mainly co-morbidity, had a significantly better outcome, median survival 40 (26, 496) months, 2-and 5-year survivals 67% (54, 84) and 32% (13, 79), respectively (Po0.001). This schedule is a feasible, tolerable and effective treatment for patients with oesophageal cancer considered unsuitable for surgery.

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“…Bronchoscopy was performed in patients with tumours of the cervical or proximal thoracic oesophagus and in patients with squamous cell carcinoma. The 1983 AJCC staging system (Table 1) was used in this study according to published recommendations (Coia et al, 2000). Patients were examined the morning prior to each chemotherapy infusion during induction chemotherapy and combined chemoradiotherapy.…”

Section: Pretreatment Evaluation and Evaluation On Studymentioning

confidence: 99%

Induction cisplatin–irinotecan followed by concurrent cisplatin–irinotecan and radiotherapy without surgery in oesophageal cancer: multicenter phase II FFCD trial

et al. 2006

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A recent phase I study showed that weekly cisplatin, irinotecan and concurrent radiotherapy can be administered with moderate toxicity in patients with oesophageal cancer. Patients with no prior treatment and oesophageal cancer stage I to III, performance status o3, caloric intake 41500 kcal day À1 were included. Chemotherapy, with cisplatin 30 mg m À2 and irinotecan 60 mg m À2 , was administered at days 1, 8, 22, 29, and concurrently with radiotherapy at days 43, 50, 64 and 71. Radiotherapy was delivered with 50 or 50.4 Gy in 25 fractions/5 weeks. Forty-three patients were included, 10 stage I, 19 stage II and 14 stage III. Mean age was 59.2 years (range 44 -79). A total of 30 out of 43 (69.8%) patients underwent all planned treatment. During induction chemotherapy, 14 severe toxicities of grade 3 or 4 in 10 patients (23.3%) were reported with 57.1% due to haematoxicity. During chemoradiotherapy, 31 severe toxicities of grade 3 or 4 with 64.5% due to haematotoxicity were reported in 18 patients. One toxic death occurred (diarrhoea grade 4). The complete clinical response rate was 58.1% (95% CI: 43.4 -72.8%). Overall survival rate at 1 and 2 years was 62.8%, (95% CI, 58.3 -77.3%) and 27.9% (95% CI, 13.4 -41.3%), respectively. In conclusion, cisplatin -irinotecan -radiotherapy is an active and well-tolerated regimen feasible in out-patients.

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Outcome of Patients Receiving Radiation for Cancer of the Esophagus: Results of the 1992-1994 Patterns of Care Study

Cited by 142 publications

References 16 publications

Combined modality chemoradiation in elderly oesophageal cancer patients

Combined modality chemoradiation in elderly oesophageal cancer patients

Definitive chemoradiation in patients with inoperable oesophageal carcinoma

Induction cisplatin–irinotecan followed by concurrent cisplatin–irinotecan and radiotherapy without surgery in oesophageal cancer: multicenter phase II FFCD trial

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