Single-Agent Versus Double-Agent Chemotherapy in Concurrent Chemoradiotherapy for Esophageal Squamous Cell Carcinoma: Prospective, Randomized, Multicenter Phase II Clinical Trial

Zhao, Zhenqun; Wen, Ya-Qing; Liao, Dongbiao; Miao, Jinlin; Gui, Yan; Cai, Hongwei; Chen, Yang; Wei, Min; Jia, Qiang; Tian, He; Sun, Mingzhong; Feng, Gang; Du, Xiaobo

doi:10.1634/theoncologist.2020-0808

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…Efficacy in the dCCRT group was similar to that of the sCCRT group, although more grade 2–4 severe toxicities were observed in the dCCRT group, including myelosuppression, leucopenia, radioactive esophagitis, and gastrointestinal reaction. Differences in intensity of chemotherapy during RT did not affect the incidence of radiation pneumonia, which was essentially consistent with the results of Li et al 13 The results of Phase II clinical trial reported by Zhao et al 14 showed that the median disease-free survival times were 20 and 21 months for the single-agent and dual agent groups, respectively, with no significant differences. However, the incidence of myelosuppression and vomiting was significantly lower in the single-agent group.…”

Section: Discussionsupporting

confidence: 89%

Efficacy and Prognostic Analysis of 315 Stage I–IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy

Cai¹,

Yang²,

Li³

2021

CMAR

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Purpose: Use of simulated integrated boost-intensity-modulated radiation therapy (SIB-IMRT) is rarely reported in the treatment of esophageal cancer. This study was performed to observe the curative effect and prognostic factors associated with concurrent chemoradiotherapy for esophageal cancer using modern radiotherapy (RT) techniques. Patients and Methods: In total, 315 patients with esophageal squamous cell carcinoma who received SIB-IMRT between 2015 and 2018 were included in this retrospective study. Median doses were planning target volume (PTV) 5400 cGy, 30 times (180cGy/fraction); planning gross tumor volume (PGTV) 6000 cGy, 30 times (200 cGy/fraction), once a day and 5 times a week. The entire period of RT was 6 weeks. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and adverse reactions were observed. Univariate analysis was performed, and factors with P<0.15 were included in multivariate analysis. Cox regression analysis was used for multivariate prognostic analysis. P<0.05 was considered statistically significant. The incidence of adverse reactions under single chemotherapy concurrent chemoradiotherapy (sCCRT) and double chemotherapy concurrent chemoradiotherapy (dCCRT) was analyzed. Results: Two-year, 3-year OS and PFS of the entire group were 49.5%, 40.2% and 40.3%, 34.0%, and the median survival time was 23.5 months. Univariate and multivariate analyses showed that T-stage (P=0.049), N-stage (P=0.024), clinical stage (P=0.041), short-term efficacy (P<0.001), and use of concurrent chemotherapy (P<0.001) were the influencing factors for OS. ORR was 87.6%. Adverse reactions were significantly increased with increasing chemotherapy dose. Conclusion:The adverse reactions of SIB-IMRT in esophageal cancer can be tolerated. T-stage, N-stage, clinical stage, short-term curative effect, and concurrent chemotherapy are the prognostic factors affecting survival. Because it has lower toxicity and is as effective as dCCRT, sCCRT should be considered in the management of esophageal cancer.

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Section: Discussionsupporting

confidence: 89%

Efficacy and Prognostic Analysis of 315 Stage I–IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy

Cai¹,

Yang²,

Li³

2021

CMAR

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“…reported higher rates of efficacy and acceptable toxicity, with 36% of patients experiencing significant toxicity. 14 Much lower rates of severe esophagitis (5.8%) and hematologic toxicity (9.8%) were observed in the study by Zhao et al 36 compared to our study. In contrast, Takeuchi et al reported a high frequency of discontinued treatment (58%), mostly for hematologic toxicity.…”

Section: Discussioncontrasting

confidence: 58%

Definitive chemoradiotherapy in elderly patients with esophageal cancer: Safety and outcome

Kiladze

Chkhaidze

Iovashvili

et al. 2023

Precision Radiation Oncology

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Objective:The efficacy and safety of definitive chemoradiotherapy (dCRT) for elderly patients with unresectable esophageal cancer (EC) are not yet fully understood. We conducted this study to evaluate the outcome and toxicity in elder patients (65 years and over) of unresectable EC treated with dCRT. Methods:From four Georgian cancer centers with a radiation oncology department, we identified 44 elderly patients with EC suitable according to the study criteria. Overall survival (OS) was estimated from the beginning of treatment and toxicity scored using CTCAE 5.0 criteria. Results:The median age of patients was 70.0 years (range 65-83 years), with male predominance (77.3%) and 59% of patients were with Eastern Cooperative Oncology Group (ECOG) performance status 1. Because of significant dysphagia (grade 3-4) nine patients underwent intervention (stenting or gastrostomy) before dCRT. More than two-thirds of patients were squamous cell histological type (77.3%). Localization of tumors was equally distributed between the middle and lower parts of the esophagus (38.6%) and in 26 patients (59.1%) tumor length was more than 5 cm. The majority of patients had stage III disease (61.4%).Median survival was 16.0 months (95% confidence interval [CI] 0-35.9). OS at 12 and 24 months was 53.7% and 43.6%, respectively. Fifteen patients (34%) were alive from 2.1 to 5.4 years after treatment. A statistically significant difference (p = 0.011) in median OS was found between patients who received full (not reached) versus overall survival (OS) was 9.0 months in patients who received nonfull dose of radiotherapy (RT) (95% CI 2.79-15.2). Additional analysis between age subgroups revealed that elder subgroup patients (>75 years) had the highest OS, compared to younger (65-70 years) and intermediate groups (71-75 years) (p = 0.001). The most common adverse events were grade 3-4 leukopenia (43.2%), anemia (29.5%), and esophagitis (27.3%). Conclusion:The results of our study support the feasibility and efficacy of dCRT for unresectable EC in carefully selected elderly patients. Survival was correlated toThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Secondly, neoadjuvant chemotherapy can lead to less extensive surgery and reduce the risk of local recurrences ( Dietz et al, 2018 ; van Ramshorst et al, 2018 ). Third, chemotherapy can enhance the local effect of radiotherapy during chemoradiation ( Geoffrois et al, 2018 ; Versteijne et al, 2020 ; Zhao et al, 2020 ). Finally, local response to palliative chemotherapy can decrease morbidity ( Vermorken et al, 2008 ; Judson et al, 2014 ; Loupakis et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Mediated Drug Delivery With a Clinical Ultrasound System: In Vitro Evaluation

et al. 2021

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Chemotherapy efficacy is often reduced by insufficient drug uptake in tumor cells. The combination of ultrasound and microbubbles (USMB) has been shown to improve drug delivery and to enhance the efficacy of several drugs in vitro and in vivo, through effects collectively known as sonopermeation. However, clinical translation of USMB therapy is hampered by the large variety of (non-clinical) US set-ups and US parameters that are used in these studies, which are not easily translated to clinical practice. In order to facilitate clinical translation, the aim of this study was to prove that USMB therapy using a clinical ultrasound system (Philips iU22) in combination with clinically approved microbubbles (SonoVue) leads to efficient in vitro sonopermeation. To this end, we measured the efficacy of USMB therapy for different US probes (S5-1, C5-1 and C9-4) and US parameters in FaDu cells. The US probe with the lowest central frequency (i.e. 1.6 MHz for S5-1) showed the highest USMB-induced intracellular uptake of the fluorescent dye SYTOX™ Green (SG). These SG uptake levels were comparable to or even higher than those obtained with a custom-built US system with optimized US parameters. Moreover, USMB therapy with both the clinical and the custom-built US system increased the cytotoxicity of the hydrophilic drug bleomycin. Our results demonstrate that a clinical US system can be used to perform USMB therapy as efficiently as a single-element transducer set-up with optimized US parameters. Therefore, future trials could be based on these clinical US systems, including validated US parameters, in order to accelerate successful translation of USMB therapy.

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Single-Agent Versus Double-Agent Chemotherapy in Concurrent Chemoradiotherapy for Esophageal Squamous Cell Carcinoma: Prospective, Randomized, Multicenter Phase II Clinical Trial

Cited by 10 publications

References 26 publications

Efficacy and Prognostic Analysis of 315 Stage I–IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy

Efficacy and Prognostic Analysis of 315 Stage I–IVa Esophageal Cancer Patients Treated with Simultaneous Integrated Boost-Intensity-Modulated Radiation Therapy

Definitive chemoradiotherapy in elderly patients with esophageal cancer: Safety and outcome

Ultrasound-Mediated Drug Delivery With a Clinical Ultrasound System: In Vitro Evaluation

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