Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma

  • Dr. Pradeep Kumar K.N. Radiation Oncologist, S.N. Medical College and Hospital, Agra, Uttar Pradesh, India
  • Dr. Ashwini L. Radiation Oncologist, S.N. Medical College and Hospital, Agra, Uttar Pradesh, India
  • Dr. Indira Yadav Radiation Oncologist, S.N. Medical College and Hospital, Agra, Uttar Pradesh, India
  • Dr. Anuj Tyagi Medical Physicist, S.N. Medical College and Hospital, Agra, Uttar Pradesh, India
  • Dr. Lakshmaiah K. C. Medical Oncologist, Department of Radiotherapy, S.N. Medical College and Hospital, Agra, Uttar Pradesh, India
Keywords: Chemotherapy, Cisplatin, Esophageal neoplasm, Radiotherapy, Esophageal carcinoma

Abstract

Background: The treatment of esophageal carcinoma may demand multiple approaches including combination of radiotherapy and chemotherapy, particularly cases which are considered unresectable, such as upper third esophageal cancers, locally advanced middle and lower third cancers.

Methods: This was a prospective, randomized, open-label, single-center study conducted between December 2014 and July 2016. Patients of either sex aged more than 18 years with the confirmed diagnosis of previously untreated advanced esophageal carcinoma were included in the study. Eligible patients were randomized to receive one of the treatments (chemo-radiotherapy [cisplatin] or radiotherapy alone). Response criteria included dysphasia free survival (DySF), disease free survival (DFS), and overall survival (OS). Tolerability was also assessed.

Results: A total of 31 patients (chemo-radiotherapy, n=13; radiotherapy alone, n=18) were enrolled in this study. At one year, the probability of remaining dysphagia free was 40% and 20%, respectively for chemo-radiotherapy and radiotherapy alone groups; and the probability of OS was 64% versus 21%, respectively. The median DFS was 12 months and 5 months for chemo-radiotherapy and radiotherapy alone group, respectively. There were no significant differences in both the groups in EBRT, total treatment duration and duration of EBRT. No patient reported thrombocytopenia or nephrotoxicity.

Conclusions: Concurrent chemo-radiotherapy with cisplatin can improve dysphasia and OS in patients with esophageal carcinoma.

Downloads

Download data is not yet available.

References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68 (6): 394-424. doi: https://doi.org/10.3322/caac.21492.

Samarasam I. Esophageal cancer in India: Current status and future perspectives. Int J Adv Med Health Res.2017;4(1):5-10. doi: http://www.ijamhrjournal.org/text.asp?2017/4/1/5/209126.

Dawsey SM, Lewin KJ, Wang GQ, Liu FS, Nieberg RK, Yu Y, et al. Squamous esophageal histology and subsequent risk of squamous cell carcinoma of the esophagus. A prospective follow-up study from Linxian, China. Cancer. 1994;74(6):1686-1692.

Dawsey SM, Lewin KJ, Liu FS, Wang GQ, Shen Q. Esophageal morphology from Linxian, China. Squamous histologic findings in 754 patients. Cancer. 1994; 73(8):2027-2037.

Yu G, Chen G, Huang B, Shao W, Zeng G. Effect of early enteral nutrition on postoperative nutritional status and immune function in elderly patients with esophageal cancer or cardiac cancer. Chin J Cancer Res. 2013; 25(3): 299-305. doi: 10.3978/j.issn.1000-9604.013.06.01.

Brown LM, Hoover RN, Greenberg RS, Schoenberg JB, Schwartz AG, Swanson GM, et al. Are racial differences in squamous cell esophageal cancer explained by alcohol and tobacco use? J Natl Cancer Inst. 1994; 86(17):1340-1345. doi: https://doi.org/10.1093/jnci/86.17.1340.

al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK, et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: An intergroup study. J Clin Oncol.1997; 15(1):277-284.

Berger AC, Farma J, Scott WJ, Freedman G, Weiner L, Cheng JD, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol. 2005;23(19):4330-4337.doi: https://doi.org/10.1200/JCO.2005.05.017.

Earlam R, Cunha-Melo JR. Esophageal squamous cell carcinomas: II. A critical view of radiotherapy. Br J Surg. 1980; 67(7):457-461. doi: https://doi.org/10.1002/bjs.1800670702.

Napier KJ, Scheerer M, Misra S. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol. 2014;6(5):112-120. doi: http://dx.doi.org/10.4251/wjgo.v6.i5.112.

Xu H, Wu S, Luo H, Chen C, Lin L, Huang H, Xue R. Prognostic value of tumor length and diameter for esophageal squamous cell cancer patients treated with definitive (chemo)radiotherapy: Potential indicators for nonsurgical T staging. Cancer Med. 2019. doi: https://doi.org/10.1002/cam4.2532.

Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: Long term follow up of a prospective randomized trial (RTOG 85 01).Radiation Therapy Oncology Group. JAMA. 1999; 281 (17): 1623-1627. doi: https://doi.org/10.1001/jama.281.17.16233.

Zhao KL, Liu G, Jiang GL, Wang Y, Zhong LJ, Wang Y, et al. Association of hemoglobin level with morbidity and mortality of patients with locally advanced esophageal carcinoma undergoing radiotherapy a secondary analysis of three consecutive clinical phase III trials. Clin Oncol (R Coll Radiol). 2006; 18(8):621-627.doi: https://doi.org/10.1016/j.clon.2006.04.015

Zhu LL, Yuan L, Wang H, Ye L, Yao GY, Liu C, et al. A meta-analysis of concurrent chemoradiotherapy for advanced esophageal cancer. PLoS One. 2015;10(6): e0128616. doi: https://doi.org/10.1371/journal.pone.0128616.

Montagnani F, Fornaro L, Frumento P, Vivaldi C, Falcone A, Fioretto L. Multimodality treatment of locally advanced squamous cell carcinoma of the esophagus: A comprehensive review and network metaanalysis. Crit Rev Oncol Hematol.2017;114:24-32. doi: https://doi.org/10.1016/j.critrevonc.2017.03.024.

Wang DB, Sun ZY, Deng LM, Zhu DQ, Xia HG, Zhu PZ. Neoadjuvant chemoradiotherapy improving survival outcomes for esophageal carcinoma: an updated meta-analysis. Chin Med J (Engl).2016; 129 (24): 2974-2982. doi: https://dx.doi.org/10.4103%2F0366-6999.195464.

Liu B, Bo Y, Wang K, Liu Y, Tang X, Zhao Y, et al. Concurrent neoadjuvant chemoradiotherapy could improve survival outcomes for patients with esophageal cancer: a meta-analysis based on random clinical trials. Oncotarget. 2017; 8 (12):20410-20417. doi: https://dx.doi.org/10.18632%2Foncotarget.14669.

Li F, Li T, Liu L, Lv J, Song Y, Li C, et al. Concurrent versus sequential chemoradiotherapy for esophageal cancer among Chinese population: a metaanalysis. Tumori. 2015; 101(4): 353-359. doi: https://doi.org/10.5301%2Ftj.5000314.

Ma HF, Lv GX, Cai ZF, Zhang DH. Comparison of the prognosis of neoadjuvant chemoradiotherapy treatment with surgery alone in esophageal carcinoma: a meta-analysis. Onco Targets Ther. 2018;11:3441-3447. doi: https://dx.doi.org/10.2147%2FOTT.S145063.

Sun L, Zhao F, Zeng Y, Yi C. Risks and Benefits of Multimodal Esophageal Cancer Treatments: A MetaAnalysis. Med Sci Monit. 2017; 23:889-910. doi: https://dx.doi.org/10.12659%2FMSM.903328.

Smith TJ, Ryan LM, Douglass HO Jr, Haller DG, Dayal Y, Kirkwood J, et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 1998;42(2):269-276. doi: https://doi.org/10.1016/S0360-3016(98)00232-6

Lyu J, Li T, Wang Q, Li F, Diao P, Liu L, Li C, Lang J. Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for stage IV esophageal squamous cell carcinoma: a retrospective controlled study. Radiat Oncol. 2018; 13(1):233. doi: https://doi.org/10.1186/s13014-018-1183-y.

Datta NR, Kumar S, Nangia S, Hukku S, Ayyagari S. A non-randomized comparison of two radiotherapy protocols in inoperable squamous cell carcinoma of the oesophagus. Clin Oncol (R Coll Radiol).1998; 10(5): 306-312. doi: 10.1016/s0936-6555(98)80083-6.

Kumar S, Dimri K, Khurana R, Rastogi N, Das KJ, Lal P. A randomised trial of radiotherapy compared with cisplatin chemo-radiotherapy in patients with unresectable squamous cell cancer of the esophagus. Radiother Oncol. 2007;83(2):139-147. doi: https://doi.org/10.1016/j.radonc.2007.03.013.

Bascoul- Mollevi C, Gourgou S, Galais MP, Raoul JL, Bouché O, Douillard JY, et al. Health-related quality of life results from the PRODIGE 5/ACCORD 17 randomized trial of FOLFOX versus fluorouracilcisplatin regimen in oesophageal cancer. Eur J Cancer. 2017;84:239-249. doi: https://doi.org/10.1016/j.ejca.2017.07.038.

Ruler MA, Peters FP, Slingerland M, Fiocco M, Grootenboers DA, Vulink AJ, et al. Clinical outcomes of definitive chemoradiotherapy using carboplatin and paclitaxel in esophageal cancer. Dis Esophagus. 2017; 30 (4):1-9. doi: https://doi.org/10.1093/dote/dow033.

Pischik VG. Editorial comments for neoadjuvant chemo-radiotherapy in the treatment of locally advanced squamous cell esophageal cancer. J Thorac Dis. 2018 ;10(11):5979-5981. doi: https://dx.doi.org/10.21037%2Fjtd.2018.10.81.

Lordick F, Mariette C, Haustermans K, Obermannová R, Arnold D. Oesophageal Cancer: ESMO Clinical Practice Guidelines. Ann Oncol. 2016; 27 (suppl 5):v50-v57.

Chen M, Li X, Chen Y, Liu P, Chen Z, Shen M, et al. Proposed revision of the 8th edition AJCC clinical staging system for esophageal squamous cell cancer treated with definitive chemo-IMRT based on CT imaging. Radiat Oncol. 2019;14(1):54. doi: https://doi.org/10.1186/s13014-019-1258-4.

Welsh J, Amini A, Likhacheva A, Erasmus JJ, Gomez D, Davila M, et al. Update: modern approaches to the treatment of localized esophageal cancer. Curr Oncol Rep. 2011;13(3):157–167. doi: 10.1007/s11912011-0158-z.

CITATION
DOI: 10.17511/ijmrr.2019.i05.05
Published: 2019-10-31
How to Cite
1.
Kumar K.N. P, L. A, Yadav I, Tyagi A, K. C. L. Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma. Int J Med Res Rev [Internet]. 2019Oct.31 [cited 2024Apr.27];7(5):370-9. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1082
Section
Original Article