Patterns of failure following combined modality therapy for esophageal cancer, 1984–1990

Kavanagh, Brian D.; Anscher, Mitchell S.; Leopold, Kenneth A.; Deutsch, Margaret; Gaydica, Elizabeth F.; Dodge, Richard K.; Allen, Kathy; Allen, David W.; Staub, Eike; Montana, Gustavo S.; Crawford, Jeffrey; Wolfe, Walter G.

doi:10.1016/0360-3016(92)90708-p

Cited by 76 publications

(37 citation statements)

References 17 publications

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“…Despite advances in cancer care, the optimal treatment regimen for palliation of dysphagia in metastatic esophageal cancer remains controversial [14][15][16][17][18][19][20] . Although two randomized controlled trials comparing endoluminal stenting with brachytherapy have shown a certain advantage for brachytherapy in terms of long-term relief from dysphagia, those trials failed to address many important issues, including the lag time between diagnosis and treatment, the time spent in treatment, and the efficacy of combined-modality treatments with both stenting and radiotherapy 12,13 .…”

Section: Discussionmentioning

confidence: 99%

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

et al. 2012

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Background: The palliation of dysphagia in metastatic esophageal cancer remains a challenge, and the optimal approach for this difficult clinical scenario is not clear. We therefore sought to define and determine the efficacy of various treatment options used at our institution for this condition. Methods: We reviewed a prospective database for all patients managed in an esophageal cancer referral centre over a 5-year period. All patients receiving palliation of malignant dysphagia were reviewed for demographics, palliative treatment modalities, complications, and dysphagia scores (0 = none to 4 = complete). The Wilcoxon signed rank test was used to determine significance (p < 0.05). Results: During 2004–2009, 63 patients with inoperable esophageal cancer were treated for palliation of dysphagia. The primary treatment was radiotherapy in 79% (brachytherapy in 18 of 50; external-beam in 10 of 50; both types in 22 of 50), and stenting in 21%. Mean wait time from diagnosis to treatment was 22 days in the stent group and 54 days in the radiotherapy group (p = 0.003). Mean duration of treatment was 1 day in the stent group and 40 days in the radiotherapy group (p = 0.001). In patients treated initially by stenting, dysphagia improved within 2 weeks of treatment in 85% of patients (dysphagia score of 0 or 1). However, 20% of patients presented with recurrence of dysphagia at 10 weeks of treatment. In the radiotherapy group, the onset of palliation was slower, with only 50% of patients palliated at 2 weeks (dysphagia score of 0 or 1). However, long-term palliation was more satisfactory, with 90% of patients remaining palliated after 10 weeks of treatment.

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Section: Discussionmentioning

confidence: 99%

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

et al. 2012

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“…Several reports have demonstrated that survival after definitive CRT is comparable to that of surgery alone [20][21][22][23][24]. Locoregional failure, however, is reported to occur in 40-60% of patients with advanced esophageal cancers after definitive CRT [22,[25][26][27][28]. For these patients, surgical resection is the only therapeutic option that can rescue them from local failure [29][30][31].…”

Section: Introductionmentioning

confidence: 97%

Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer

Miyata

Yamasaki

Takiguchi

et al. 2009

Journal of Surgical Oncology

103

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“…27 Other studies have also found a predominance of local-regional failure, even when combined with chemotherapy. [22][23][24]27,31,51 Recent data indicate that combined-modality therapy involving concurrent chemotherapy plus radiation is superior to radiation alone. 44 We conclude that the preliminary analysis of this study demonstrates that chemotherapy with cisplatin and 5-FU could be safely combined with twice-daily radiotherapy in patients with advanced e,ophageal carcinoma with acceptable toxicity yielding a satisfactory response, but local-regional failure remains the principal cause of death.…”

Section: Discussionmentioning

confidence: 98%

Combined chemotherapy with twice-daily radiation therapy for inoperable squamous cell carcinoma of the thoracic esophagus

et al. 1997

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Background: A study with chemotherapy and twice-a-day radiotherapy in patients with esophageal carcinoma was performed to evaluate toxicity and efficacy. Methods: Thirty-seven patients with squamous cell carcinoma of the thoracic esophagus (1, stage IIB; 19, stage III; 1 7, stage IV) were enrolled. The chemotherapy regimen consisted of 3 cycles with cisplatin (70 mg/m 2 on day 1 ) and 96-hour continuous infusion 5-fluorouracil (700 mg/m 2 per day on days 1 to 4). Second and third cycles were initiated on day 22 and day 92, respectively. Radiotherapy was administered twice daily with concomitant boost technique over days 43 to 75, up to a total dose of 60 Gy. Daily fractions were 2.0 Gy for large fields and 1.0 Gy for small fields at 4-to 6-hour intervals. Results: Twenty-nine patients (78%) received the full treatment. Of the 36 patients who started radiotherapy, 94% were able to complete the full course. Grade 3+ toxicities observed were leukopenia 5%, anemia 14%, thrombocytopenia 5%, vomiting 14%, esophagitis 5%, pulmonary toxicity 5%, cardiac toxicity 3%, hepatic dysfunction 3%, and nephrotoxicity 3%. Of the 36 patients who started radiotherapy, 8 (22%) showed complete response, and 16 (44%) had partial response. The median survival time was 9 months, with a 1 -year actuarial survival rate of 33%. Death was due to local-regional tumor manifestations in 18 patients. Conclusion:The preliminary analysis showed that this treatment scheme was well tolerated with acceptable toxicity, but local-regional failure remains the principal cause of death. New treatment schemes such as concurrent use of chemotherapy with radiation warrant further investigation.IntJ Clin Onco11997;2: [189][190][191][192][193][194][195][196]

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Patterns of failure following combined modality therapy for esophageal cancer, 1984–1990

Cited by 76 publications

References 17 publications

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

What Is the Optimal Management of Dysphagia in Metastatic Esophageal Cancer?

Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer

Combined chemotherapy with twice-daily radiation therapy for inoperable squamous cell carcinoma of the thoracic esophagus

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