Progress Report of Combined Chemoradiotherapy Versus Radiotherapy Alone in Patients With Esophageal Cancer

Al-Sarraf, M.; Martz, Karen; Herskovic, Arnold; Leichman, Lawrence; Brindle, Jeffrey; Vaitkevicius, V. K.; Cooper, J.; Byhardt, R.; Davis, Lawrence P.; Emami, Bahman

doi:10.1200/jco.1997.15.2.866

Cited by 9 publications

(11 citation statements)

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“…However, only the combination of radiotherapy with chemotherapy seems to impact on overall survival. This has already been shown in the framework of prospective randomized trials [8,32,33] and also for patients treated along the given trial protocols but formally outside of the randomized trial [7]. However, no such data have been shown for a non-selected patient cohort.…”

Section: Discussionmentioning

confidence: 94%

Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

et al. 2012

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Background and objectivesTreatment options for oesophageal cancer have changed considerably over the last decades with the introduction of multimodal treatment concepts dominating the progress in the field. However, it remains unclear in how far the documented scientific progress influenced and changed the daily routine practice. Since most patients with oesophageal cancer generally suffer from reduced overall health conditions it is uncertain how high the proportion of aggressive treatments is and whether outcomes are improved substantially. In order to gain insight into this we performed a retrospective analysis of patients treated at a larger tertiary referral centre over time course of 25 years.Patients and methodsData of all patients diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma (AC) of the oesophagus, treated between 1983 and 2007 in the department of radiation oncology of the LMU, were obtained. The primary endpoint of the data collection was overall survival (calculated from the date of diagnosis until death or last follow up). Changes in basic clinical characteristics, treatment approach and the effect on survival were analysed after dividing the cohort into five subsequent time periods (I-V) with 5 years each. In a second analysis any pattern of change regarding the use of radio(chemo)therapy (R(C)T) with and without surgery was determined.ResultsIn total, 503 patients with SCC (78.5%) and AC (18.9%) of the oesophagus were identified. The average age was 60 years (range 35-91 years). 56.5% of the patients were diagnose with advanced UICC stages III-IV. R(C)T was applied to 353 (70.2%) patients; R(C)T+ surgery was performed in 134 (26.6%) patients, 63.8% of all received chemotherapy (platinum-based 5.8%, 5-fluorouracil (5-FU)12.1%, 42.3% 5-FU and mitomycin C (MMC)). The median follow-up period was 4.3 years. The median overall survival was 21.4 months. Over the time, patients were older, the formal tumour stage was more advanced, the incidence of AC was higher and the intensified treatment had a higher prevalence. However there was only a trend for an improved OS over the years with no difference between RCT with or without surgery (p = 0.09). The use of radiation doses over 54 Gy and the addition of chemotherapy (p = 0.002) were associated with improved OS.ConclusionAlthough more complex treatment protocols were introduced into clinical routine, only a minor progress in OS rates was detectable. Main predictors of outcome in this cohort was the addition of chemotherapy. The addition of surgery to radio-chemotherapy may only be of value for very limited patient groups.

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Section: Discussionmentioning

confidence: 94%

Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

et al. 2012

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“…Combined modality regimens using chemotherapy and radiation therapy have been reported to be superior in increasing local control, disease-free survival, and overall survival, compared with radiation therapy alone. [2][3][4][5] The results of such combined regimens are also superior to those of an esophagectomy alone. 6 However, the rates of unsuccessful local control after chemoradiation without surgery varied from 17% to 45%.…”

Section: Discussionmentioning

confidence: 95%

A second primary esophageal cancer developing 7 years after chemoradiotherapy for advanced esophageal cancer

Suto

Enjoji

Okudaira

et al. 2001

Journal of Gastroenterology

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We report a rare case of advanced carcinoma and a second primary carcinoma of the esophagus, both of which were successfully cured by chemotherapy and operation at different times. In 1991, a 38-year-old Japanese man was diagnosed with advanced esophageal cancer, which was unresectable because of the bronchial invasion of the tumor. He was given chemotherapy with cisplatin (CDDP), combined with radiotherapy. During a 4-year follow-up, neither regrowth of the primary tumor nor distant metastasis occurred. In 1995, esophagoscopy demonstrated a lugol-unstained region located 3 cm distal from the area of radiation to the primary lesion shown by esophagography. Histological examination of a biopsy specimen showed the mucosa to be normal. Nevertheless, yearly surveillance by endoscopy and histological examinations showed that the mucosa of the esophagus gradually began to demonstrate mild dysplasia, followed by severe dysplasia; in 1998, a diagnosis of squamous cell carcinoma was made. Esophagectomy with lymph node dissection was performed. Microscopic examination revealed that there had been pathologic complete response for the original advanced esophageal cancer.

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“…However, the 5-year survival rate remains approximately 20% with the 5-year survival rate for all the patients with esophageal cancer being <10% (91). When administered in doses of 5,500-6,500 cGy, primary radiation therapy is associated with a 5-year survival rate no different from that of radical surgery (6-10%) without the preoperative morbidity.…”

Section: Gastrointestinal Cancermentioning

confidence: 99%

“…Data from a randomized trial including 120 patients with localized squamous cell or adenocarcinoma of the esophagus, with a minimum followup time of 5 years, have shown a statistically significant prolongation in survival when 5-fluorouracil and cisplatin chemotherapy is given concomitantly with radiation therapy in comparison to radiation therapy alone (91).…”

Section: Gastrointestinal Cancermentioning

confidence: 99%

Update in Internal Medicine

López-Jiménez

Brito

Aude

et al. 2000

Archives of Medical Research

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More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years. It is focused on results from randomized clinical trials and well-designed observational research. Findings were included preferentially if they showed solid results, and we avoided as much as possible including only preliminary data, or results that included only non-clinical outcomes.Some of the most relevant findings reported here include the significant benefit of statins in patients with coronary artery disease even with mean cholesterol level. It also provides a substantial review of the most significant trials assessing the effectiveness of IIb/IIIa receptor blockers. In gastroenterology many advances have been made in the H. pylori eradication, and the finding that the cure of H. pylori infection may be followed by gastroesophageal reflux disease. Some new antivirals have shown encouraging results in patients with chronic hepatitis. In the infectious disease arena, the late breaking trials in anti-retroviral disease are discussed, as well as the new trends regarding antibiotic resistance. This review approaches also the role of leukotriene modifiers in the treatment of asthma and discusses the benefit of using methylprednisolone in patients with adult respiratory distress syndrome, among many other advances in internal medicine.

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Progress Report of Combined Chemoradiotherapy Versus Radiotherapy Alone in Patients With Esophageal Cancer

Cited by 9 publications

References 0 publications

Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

A second primary esophageal cancer developing 7 years after chemoradiotherapy for advanced esophageal cancer

Update in Internal Medicine

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