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Management of Locally Advanced Carcinoma Oesophagus with Radiation/Chemoradiation: Single Institute Experience

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Abstract

Purpose

Oesophageal malignancy is the fourth commonest cancer which has a very poor outcome. In the management of oesophageal malignancy, radiation therapy is underutilized by many physicians due to feared complications though its role is well proven in literature. This study brings the role of radiation therapy in terms of loco-regional and distant relapse. This study characterizes demographic characteristics, treatment modality and the impact of these on recurrence-free survival of locally advanced carcinoma oesophagus.

Method

In a retrospective analysis over a period of 24 months, 28 patients diagnosed to have locally advanced oesophageal malignancy were included. Neoadjuvant chemotherapy was carried out in 4 patients and concurrent chemoradiotherapy in 18 patients. Among the 28 patients, 7 patients who were operable and fit underwent surgery 6–8 weeks after completion of the planned neoadjuvant therapy. All patients received concurrent chemoradiation for a period of 5 weeks with platinum and/or taxane-based chemotherapy.

Results

With a median follow-up of 12 months, loco-regional recurrence and distant relapse were substantially less with 14 and 10 %, respectively. The Kaplan-Meier recurrence-free survival was 60 % at 24 months. All patients who had surgery as a part of the multimodality management were disease free at the last follow-up.

Conclusion

In locally advanced oesophageal malignancy, radiation therapy plays an important role in downsizing the tumour for operability or can also be utilized as the sole modality of management.

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References

  1. ‘GLOBOCAN 2008: Country Fast Stat. WHO-International Agency For Research on Cancer’. [Online]. Available: http://globocan.iarc.fr/factsheet.asp. [Accessed: 20-Jan-2013].

  2. Sinha R, Anderson DE, McDonald SS, Greenwald P. Cancer risk and diet in India. J Postgrad Med. 2003;49(3):222.

    CAS  PubMed  Google Scholar 

  3. Kollarova H, Machova L, Horakova D, Janoutova G, Janout V. Epidemiology of esophageal cancer—an overview article. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007;151(1):17–20.

    Article  PubMed  Google Scholar 

  4. Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JAJ, 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):1,623–7.

    Article  CAS  Google Scholar 

  5. Hironaka S, Ohtsu A, Boku N, Muto M, Nagashima F, Saito H, et al. Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2–3)N(any) M(0) squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys. 2003;57(2):425–33.

    Article  PubMed  Google Scholar 

  6. Tobias JS. Treatment of oesophageal cancer. J R Soc Med. 2002;95(1):55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12(7):681–92.

    Article  PubMed  Google Scholar 

  8. Susman E. Neoadjuvant chemo allows for surgery in “inoperable” esophageal cancer. Oncol Times. 2004;26(4):8–11.

    Article  Google Scholar 

  9. ‘Is surgery necessary following chemoradiation for patients with locally advanced cancer of the oesophagus?’

  10. Jose Tony, Sunil Kumar, and V. Thomas, ‘Time trends and pathological profile of carcinoma lower oesophagus and gastro-oesophageal junction over the last 20 years—an experience from South India’. [Online]. Available: http://www.tropicalgastro.com/printerfriendly.aspx?id = 42. [Accessed: 29-Jan-2013].

  11. Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326(24):1,593–8.

    Article  CAS  Google Scholar 

  12. Tepper J, Krasna MJ, Niedzwiecki D, Hollis D, Reed CE, Goldberg R, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. JCO. 2008;26(7):1,086–92.

    Article  CAS  Google Scholar 

  13. Burmeister BH, Thomas JM, Burmeister EA, Walpole ET, Harvey JA, Thomson DB, et al. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase II trial. Eur J Cancer. 2011;47(3):354–60.

    Article  PubMed  Google Scholar 

  14. Shapiro J, van Lanschot JJB, Hulshof MCCM, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1,090–8.

    Article  Google Scholar 

  15. Minsky BD, Neuberg D, Kelsen DP, Pisansky TM, Ginsberg RJ, Pajak T, et al. Final report of Intergroup Trial 0122 (ECOG PE-289, RTOG 90–12): phase II trial of neoadjuvant chemotherapy plus concurrent chemotherapy and high-dose radiation for squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys. 1999;43(3):517–23.

    Article  CAS  PubMed  Google Scholar 

  16. ‘NCCN 2016 esophageal.pdf’.

  17. Le Prise E, Etienne PL, Meunier B, Maddern G, Ben Hassel M, Gedouin D, et al. A randomized study of chemotherapy, radiation therapy, and surgery versus surgery for localized squamous cell carcinoma of the esophagus. Cancer. 1994;73(7):1,779–84.

    Article  Google Scholar 

  18. Almhanna K, Strosberg JR. Multimodality approach for locally advanced esophageal cancer. World J Gastroenterol. 2012;18(40):5,679–87.

    Article  Google Scholar 

  19. Daly JM, Fry WA, Little AG, Winchester DP, McKee RF, Stewart AK, et al. Esophageal cancer: results of an American College of Surgeons Patient Care Evaluation Study. J Am Coll Surg. 2000;190(5):562–72.

    Article  CAS  PubMed  Google Scholar 

  20. Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med. 1997;337(3):161–7.

    Article  CAS  PubMed  Google Scholar 

  21. Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335(7):462–7.

    Article  CAS  PubMed  Google Scholar 

  22. Meguid RA, Hooker CM, Taylor JT, Kleinberg LR, Cattaneo SM, Sussman MS, et al. Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: does the pattern of recurrence differ for patients with complete response and those with partial or no response? J Thorac Cardiovasc Surg. 2009;138(6):1,309–17.

    Article  Google Scholar 

  23. Ilson DH. Esophageal cancer chemotherapy: recent advances. Gastrointest Cancer Res. 2008;2(2):85–92.

    PubMed  PubMed Central  Google Scholar 

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Correspondence to Damodara Kumaran.

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Kumaran, D., John, S., Isiah, R. et al. Management of Locally Advanced Carcinoma Oesophagus with Radiation/Chemoradiation: Single Institute Experience. J Gastrointest Canc 47, 313–317 (2016). https://doi.org/10.1007/s12029-016-9825-5

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