Skip to main content

Advertisement

SpringerLink
Log in

Clinical results of definitive-dose (50 Gy/25 fractions) preoperative chemoradiotherapy for unresectable esophageal cancer

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

The clinical results of definitive-dose preoperative chemoradiotherapy (CRT) of 50 Gy/25 fractions/5 weeks for unresectable esophageal cancer were analyzed.

Methods

Inclusion criteria were unresectable esophageal squamous cell carcinoma with T4b or mediastinal lymph nodes invading to the trachea or aorta. Radiation therapy of 50 Gy/25 fractions/5 weeks was combined concurrently with two courses of FP therapy (CDDP 70 mg/m2 + 5-FU 700 mg/m2/d × 5 days: day 1–5, day 29–33). Tumor response was evaluated 4 weeks after completion of RT. Subtotal esophagectomy was planned 6–8 weeks after RT.

Results

Thirty patients (26 male and 4 female) aged from 50−78 years (median 66) were enrolled between 2008 and 2011. The clinical stages according to the 7th edition of UICC were stages II/III/IV, 1/23/6; T1/2/3/4, 1/1/4/24; and N0/1/2/3, 3/25/1/1. All 30 patients completed RT of 50 Gy/25 fractions. Initial tumor responses were 21 patients with resectable disease, 7 with unresectable disease, and 2 with progressive disease. Subtotal esophagectomy was performed in 18 (60 %) of the 30 patients. Pathological complete response was obtained in five (28 %) patients. There were two patients with hospitalization death after surgery (11 %). Six of the 7 patients who still had unresectable disease were treated with 1–3 courses of docetaxel, CDDP and 5-FU. Three patients treated without surgery showed long-term survival. The 3-year loco-regional control rate and the 3-year overall survival rate for the 30 patients were 70 and 49 %, respectively.

Conclusions

Definitive-dose preoperative CRT was feasible, and is a promising treatment strategy for unresectable esophageal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. The Japan Esophageal Society (2012) Guidelines for diagnosis and treatment of carcinoma of the esophagus April, 2012th edn. Kanehara, Tokyo

    Google Scholar 

  2. Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174

    Article  CAS  PubMed  Google Scholar 

  3. Nishimura Y, Suzuki M, Nakamatsu K et al (2002) Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula. Int J Radiat Oncol Biol Phys 53:134–139

    Article  CAS  PubMed  Google Scholar 

  4. Ohtsu A, Boku N, Muro K et al (1999) Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol 17:2915–2921

    CAS  PubMed  Google Scholar 

  5. Ishida K, Ando N, Yamamoto S et al (2004) Phase II study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group Trial (JCOG9516). Jpn J Clin Oncol 34:615–619

    Article  PubMed  Google Scholar 

  6. Nishimura Y, Koike R, Ogawa K et al (2012) Clinical practice and outcome of radiotherapy for esophageal cancer between 1999 and 2003: the Japanese Radiation Oncology Study Group (JROSG) Survey. Int J Clin Oncol 17:48–54

    Article  PubMed  Google Scholar 

  7. Fiorica F, Di Bona D, Schepis F et al (2004) Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut 53:925–930

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Jin HL, Zhu H, Ling TS et al (2009) Neoadjuvant chemoradiotherapy for resectable esophageal carcinoma: a meta-analysis. World J Gastroenterol 47:5983–5991

    Article  Google Scholar 

  9. Courrech Staal EF, Aleman BM, Boot H et al (2010) Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer. Br J Surg 97:1482–1496

    Article  CAS  PubMed  Google Scholar 

  10. Jl Geh, Bond SJ, Bentzen SM et al (2006) Systematic overview of preoperative (neoadjuvant) chemoradiotherapy trials in oesophageal cancer: evidence of a radiation and chemotherapy dose response. Radiother Oncol 78:236–244

    Article  Google Scholar 

  11. Tepper J, Krasna MJ, Niedzwiecki D et al (2008) Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 26:1086–1092

    Article  CAS  PubMed  Google Scholar 

  12. Cooper JS, Guo MD, Herskovic et al (1999) Chemoradiotherapy of locally advanced esophageal cancer. JAMA 17:1623–1627

    Google Scholar 

  13. Picus D, Balfe DM, Koehler RE et al (1983) Computed tomography in the staging of esophageal carcinoma. Radiology 146:433–438

    Article  CAS  PubMed  Google Scholar 

  14. Bedenne L, Michel P, Bouché O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168

    Article  CAS  PubMed  Google Scholar 

  15. Walsh TN, Noonan N, Hollywood D et al (1996) A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 335:462–467

    Article  CAS  PubMed  Google Scholar 

  16. Bosset JF, Gignoux M, Triboulet JP et al (1997) Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 337:161–167

    Article  CAS  PubMed  Google Scholar 

  17. Dähn D, Martell J, Vorwerk H et al (2010) Influence of irradiated lung volumes on perioperative morbidity and mortality in patients after neoadjuvant radiochemotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys 77:44–52

    Article  PubMed  Google Scholar 

  18. Hurmuzlu M, Øvrebø K, Wentzel-Larsen T et al (2010) High-dose preoperative chemoradiotherapy in esophageal cancer patients does not increase postoperative pulmonary complications: correlation with dose-volume histogram parameters. Radiother Oncol 97:60–64

    Article  PubMed  Google Scholar 

  19. Yano M, Tsujinaka T, Shiozaki H et al (1999) Concurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinma of the esophagus. J Surg Oncol 70:25–32

    Article  CAS  PubMed  Google Scholar 

  20. de Manzoni G, Pedrazzani C, Pasini F et al (2007) Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol 95:261–266

    Article  PubMed  Google Scholar 

  21. Shimoji H, Karimata H, Nagahama M et al (2013) Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: results of a prospective cohort study. World J Surg 37:2180–2188

    Article  PubMed  Google Scholar 

  22. Tachimori Y, Ozawa S, Fujishiro M et al (2014) Comprehensive registry of esophageal cancer in Japan, 2006. Esophagus 11:21–47

    Article  Google Scholar 

  23. Fujiwara Y, Yoshikawa R, Kamikonya N et al (2012) Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients. Oncol Rep 28:446–452

    CAS  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Kinki University Faculty of Medicine, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Kazuki Ishikawa, Kiyoshi Nakamatsu & Yasumasa Nishimura

  2. Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan

    Osamu Shiraishi & Takushi Yasuda

Authors
  1. Kazuki Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kiyoshi Nakamatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osamu Shiraishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takushi Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasumasa Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuki Ishikawa.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ishikawa, K., Nakamatsu, K., Shiraishi, O. et al. Clinical results of definitive-dose (50 Gy/25 fractions) preoperative chemoradiotherapy for unresectable esophageal cancer. Int J Clin Oncol 20, 531–537 (2015). https://doi.org/10.1007/s10147-014-0736-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-014-0736-9

Keywords

Search

Navigation