Shifting Practice in Definitive Chemoradiation for Localized Esophageal Cancer

Qu, Xuanlu; Biagi, James; Hopman, Wilma M.; Mahmud, Aamer

doi:10.3747/co.24.3677

Cited by 8 publications

(13 citation statements)

References 25 publications

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“…However, it should be noted these studies used docetaxel–cisplatin, whereas we used paclitaxel–carboplatin. In contrast to our findings, Qu et al (2017) reported that PF ( n = 34) was superior to PC ( n = 26) in inoperable EC 17 . Moreover, some studies found similar outcomes between PF and PC in concurrent CRT 14‐16,19,21 .…”

Section: Discussioncontrasting

confidence: 99%

Definitive concurrent chemoradiotherapy with paclitaxel plus carboplatin is superior to cisplatin plus 5‐fluorouracil in patients with inoperable esophageal squamous cell carcinoma using retrospective, real‐world evidence

et al. 2021

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Background The optimal definitive chemotherapy regimen during concurrent chemoradiotherapy (CRT) for patients with advanced esophageal squamous cell carcinoma (ESCC) remains unclear because of conflicting evidence. This study aimed to compare the effectiveness of taxane‐based chemotherapy with that of conventional cisplatin plus 5‐fluorouracil (PF) as the chemotherapy regimen in definitive CRT for ESCC. Patients and Methods This retrospective study included patients with ESCC who received paclitaxel plus carboplatin (PC) or PF during definitive CRT between May 2012 and February 2015 in a medical center in Taiwan. Survival outcomes were compared after adjustment for risk factors. Results Overall, 229 patients were evaluated. Patients in the PC group had an objective response rate of 71.1% compared with the 51.4% of the PF group (p = 0.016). The PC group showed a significantly longer progression‐free survival (PFS, p = 0.002) and overall survival (OS, p = 0.019) than the PF group. Salvage surgery also helped prolong both the PFS and OS (p < 0001). Sex (male vs. female, HR, 1.831; 95% CI, 1.016–3.303), clinical stage (HR, 1.282; 95% CI, 1.069–1.537), accumulative radiation dose (≥41.4 Gy vs. <41.4 Gy; HR, 0.640; 95% CI, 0.413–0.993), salvage surgery (yes vs. no, HR: 0.412, 95% CI: 0.298–0.570), and regimen (PF vs. PC; HR, 1.514; 95% CI, 1.109–2.067) were independent prognostic factors for cancer mortality. Conclusion Compared with the PF regimen, the PC regimen for definitive CRT yielded significantly increased response rates and longer survival times; therefore, the PC regimen may be preferable for chemotherapy for definitive CRT in patients with advanced ESCC.

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Section: Discussioncontrasting

confidence: 99%

Definitive concurrent chemoradiotherapy with paclitaxel plus carboplatin is superior to cisplatin plus 5‐fluorouracil in patients with inoperable esophageal squamous cell carcinoma using retrospective, real‐world evidence

et al. 2021

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“…In the setting of dCRT, CP seemed to yield significantly inferior survival, with an HR >3 despite adjusting for age and radiotherapy doses received and additional baseline characteristics using IPTW modeling. The OS data for the dCRT subcohort mirror results from previous reports [12]. The drastically inferior outcomes of the CP regimen seen highlight the need for caution before adopting CP as a preferred approach in dCRT.…”

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

“…While dCRT of 50 Gy with CF is established as the standard of care [6, 7], CP has been increasingly utilized without supporting prospective data [12] in accordance with recommendations by the US NCCN guideline [8]. The literature comparing CP to CF has been extremely limited for Western patients receiving dCRT, with two comparative retrospective studies, to our knowledge, which published mixed results [12-14]. Both studies found comparable survival outcomes with CP and CF, but the median OS of the CF groups was significantly shorter (16.1 months [13] and 24.2 months [14] compared to the 74.6 months in our study).…”

Section: Discussionmentioning

confidence: 99%

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Chemoradiotherapy Using Carboplatin plus Paclitaxel versus Cisplatin plus Fluorouracil for Esophageal or Gastroesophageal Junction Cancer

et al. 2020

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Background: Trimodality therapy (TMT) with neoadjuvant chemoradiotherapy (nCRT) using concurrent carboplatin plus paclitaxel (CP) followed by surgery is the standard of care for locoregional esophageal or gastroesophageal junction (GEJ) cancers. Alternatively, nCRT with cisplatin plus fluorouracil (CF) can be used. Definitive chemoradiotherapy (dCRT) with CP or CF can be used if surgery is not planned. In the absence of comparative trials, we aimed to evaluate outcomes of CP and CF in the settings of TMT and dCRT. Methods: A single-site, retrospective cohort study was conducted at the Princess Margaret Cancer Centre to identify all patients who received CRT for locoregional esophageal or GEJ cancer. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method and multivariable Cox regression model. The inverse probability treatment weighting (IPTW) method was used for sensitivity analysis. Results: Between 2011 and 2015, 93 patients with esophageal (49%) and GEJ (51%) cancers underwent nCRT (n = 67; 72%) or dCRT (n = 26; 28%). Median age was 62.3 years and 74% were male. Median follow-up was 23.9 months. Comparing CP to CF in the setting of TMT, the OS and DFS rates were similar. In the setting of dCRT, CP was associated with significantly inferior 3-year OS (36 vs. 63%; p = 0.001; HR 3.1; 95% CI: 1.2–7.7) and DFS (0 vs. 41%; p = 0.004; HR 3.6; 95% CI: 1.4–8.9) on multivariable and IPTW sensitivity analyses. Conclusions: TMT with CF and CP produced comparable outcomes. However, for dCRT, CF may be a superior regimen.

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“…Carboplatin-paclitaxel is considered more tolerable than platinum-fluoropyrimidine based on comparison of the CROSS trial with historical controls (ie, RTOG 8501 and Intergroup [INT] 0123) and retrospective studies. 1 , 23 , 24 , 25 The ongoing PReoperative Chemoradiation for Resectable Esophageal and Junctional Cancer (PROTECT-1402) phase II trial will compare preoperative folinic acid, 5-FU, and oxaliplatin to carboplatin-paclitaxel. 26 Single-agent chemotherapy typically is considered noncurative 27 ; notably, 20% of our study population received fluoropyrimidine alone.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Tolerability of Definitive and Preoperative Chemoradiation in Elderly Patients With Esophageal Cancer: A Retrospective Institutional Review

Rahimy

Koong

Toesca

et al. 2020

Advances in Radiation Oncology

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Purpose Our purpose was to report outcomes of elderly patients who underwent definitive treatment involving radiation therapy for esophageal cancer at our institution. Methods and Materials We performed a retrospective review of patients aged ≥75 years with esophageal cancer treated with definitive radiation therapy (≥45 Gy) at our institution from 1997 to 2019. Acute and late Radiation Therapy Oncology Group grade 3+ toxicities were recorded. Survival was estimated using the Kaplan-Meier method. Results Of the 89 patients included, median age was 80 and 78% were male. Median adjusted Charlson Comorbidity Index and Karnofsky Performance Status were 5 (3-12) and 80 (50-100), respectively. The majority of cancers were adenocarcinoma (58%), distal (67%), and stage III (62%). Fifty-eight percent underwent definitive chemoradiotherapy, and one-third underwent preoperative intent chemoradiotherapy. Median prescribed dose was 50 Gy (45-66 Gy), and intensity modulated radiation therapy was used in 76%. Eighty-five percent completed the radiation therapy course. Among these, 20% had radiation therapy breaks. For those receiving concurrent chemotherapy, 37% had a dose reduction and 39.5% had a break/cycle reduction. Acute grade 3+ toxicity was 22%, with 2% grade 5 toxicity. Twenty-one of the 29 patients (72%) treated with preoperative intent underwent surgery. There were no deaths 90 days postoperatively. For patients who underwent surgery, 1- and 2-year overall survival were 95% and 84%. For those who did not undergo surgery, 1- and 2-year overall survival were 70% and 52%. Conclusions There is a role for aggressive radiation therapy in well-selected elderly patients with esophageal cancer. However, optimization of supportive care, chemotherapy regimens, radiation therapy dose/fractionation, and surgical indications are needed to reduce toxicity.

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Shifting Practice in Definitive Chemoradiation for Localized Esophageal Cancer

Abstract: BackgroundThe efficacy of carboplatin-paclitaxel in the trimodality setting was demonstrated in the cross

Cited by 8 publications

References 25 publications

Definitive concurrent chemoradiotherapy with paclitaxel plus carboplatin is superior to cisplatin plus 5‐fluorouracil in patients with inoperable esophageal squamous cell carcinoma using retrospective, real‐world evidence

Definitive concurrent chemoradiotherapy with paclitaxel plus carboplatin is superior to cisplatin plus 5‐fluorouracil in patients with inoperable esophageal squamous cell carcinoma using retrospective, real‐world evidence

Chemoradiotherapy Using Carboplatin plus Paclitaxel versus Cisplatin plus Fluorouracil for Esophageal or Gastroesophageal Junction Cancer

Outcomes and Tolerability of Definitive and Preoperative Chemoradiation in Elderly Patients With Esophageal Cancer: A Retrospective Institutional Review

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