Safety and Efficacy of Concurrent Cisplatin and Radiotherapy in Inoperable or Metastatic Squamous Cell Esophageal Cancer

Kumar, Shaleen; Dimri, Kislay; Datta, Niloy Ranjan; Rastogi, Neeraj; Lal, Punita; Das, K.J. Maria; Ayyagari, S.

doi:10.1080/028418602320405050

Cited by 6 publications

(2 citation statements)

References 16 publications

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“…This suggests that our schedule was better than the weekly CDDP-40 mg/m 2 schedule in terms of compliance and hematologic toxicity and comparable in terms of survival outcomes. We have previously reported our experience with weekly CDDP at 35 mg/m 2 concurrent with concomitant boost RT in head and neck cancer (Kumar et al, 2005) and with conventional RT in oesophageal cancer (Kumar et al, 2002) and have achieved a favourable outcome.…”

Section: Discussionmentioning

confidence: 99%

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Dimri¹,

Pandey²,

Trehan³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: Platinum based concurrent chemo-radiation is the de-facto standard of care in the non-surgical management of locally-advanced head and neck cancer of squamous origin. Three-weekly single agent cisplatin at 100 mg/m 2 concurrent with radical radiotherapy has demonstrated consistent improvement in loco-regional control and survival. This improvement is however at the cost of considerable hematologic toxicity and poor overall compliance. The routine use of this regime is improbable in developing countries with limited resources. We therefore aimed to determine the safety and efficacy of an alternative regime of weekly cisplatin and concurrent radiotherapy in such patients. Materials and Methods: January-05 and April-12, 188 patients of locally-advanced head and neck cancer of squamous origin were treated with concurrent weekly-cisplatin at 35mg/m 2 and conventional radiotherapy 60-66Gy/30-33 fractions/5days per week. Results: Overall, 95% patients received planned doses of RT while 74% completed within the stipulated overall treatment time of <50 days. Eighty-two percent received at-least 5 weekly cycles. Grade-III/IV mucositis was seen in 58%/9% respectively, which resulted in mean weight loss of 9.2% from a pre-treatment mean of 54.5 kg. Grade-III hematologic toxicity-0.5%; grade II nephrotoxicity-2.5% and grade III emesis-3% were also seen. Grade-III/IV subcutaneous toxicity-10%/1% and grade-III/IV xerostomia-10%/0% were observed. Complete responses at the primary site, regional nodes and overall disease were seen in 86%, 89% and 83% patients respectively. The median and 5-years disease-free survival were 26 months and 39.4% respectively, while the median and overall survival were 27 months and 41.8% respectively. Conclusions: Weekly-cisplatin at 35 mg /m2 when delivered concurrently with conventional radical RT (at-least 66y/33 fractions) in locally-advanced head and neck cancer is well tolerated with minimal hematologic and neprologic toxicity and can be routinely delivered on an out-patient basis. It is an effective alternative to the standard 3-weekly cisplatin especially in the context of developing countries.

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Section: Discussionmentioning

confidence: 99%

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Dimri¹,

Pandey²,

Trehan³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…Majority (77%) of the patients completed their planned treatment without any interruption, 30 (10%) patients were hospitalized during course of treatment but completed the planned treatment after recovering from acute illnesses. This higher compliance to treatment could possibly be due to the smaller target volumes unlike the earlier RTOG trials where prophylactic nodal irradiation was practiced(3,7), omission of infusional 5-FU and use of single agent platinum in majority of patients (103/149 - 70%) in the concurrent setting leading to better tolerability(27). With paclitaxel and carboplatin concurrent regimen, we had earlier reported a clinically significant incidence in grade 3 toxicity of 56% with 60% patients developing chronic toxicity of any grade(8).…”

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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Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus

Wong

Malthaner

2006

Cochrane Database of Systematic Reviews

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Safety and Efficacy of Concurrent Cisplatin and Radiotherapy in Inoperable or Metastatic Squamous Cell Esophageal Cancer

Cited by 6 publications

References 16 publications

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

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

Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus

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