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Long-Term Outcome of Mitomycin C- and 5-FU-Based Primary Radiochemotherapy for Esophageal Cancer

Langzeitergebnisse nach primärer Radiochemotherapie mit Mitomycin C und 5-Fluorouracil bei Ösophaguskarzinom

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Background and Purpose:

For definitive radiochemotherapy, 5-fluorouracil/cisplatin protocols have been considered the standard of care for esophageal carcinoma over the last 2 decades. By contrast, most patients treated at the University Hospital, LMU Munich, Germany, received 5-fluorouracil/mitomycin C. The objective of this retrospective analysis was to determine the value of 5-fluorouracil/mitomycin-C-based therapy.

Patients and Methods:

Tumor stage, treatment received, and outcome data of patients treated for esophageal cancer between 1982 and 2007 were collected; endpoint of the analysis was overall survival.

Results:

298 patients with inoperable cancer of the esophagus were identified (16.8% adenocarcinoma, 77.5% squamous cell carcinoma). At diagnosis, 61.7% (184/298) had UICC stage III–IV, 54.4% (162/298) positive lymph nodes, and 26.5% (79/298) metastatic disease. 74.5% of all patients (222/298) received radiation doses between 55 and 65 Gy, 65.8% (196/298) were subjected to concomitant chemotherapy. The median follow-up period (patients alive) was 4.1 years. A significant increase of overall survival (p < 0.0001) in the radiochemotherapy versus the radiotherapy-alone group was observed. 52% (102/196) in the 5-fluorouracil/ mitomycin C group had tumor stages comparable to the RTOG 85-01 study cohort (T1–3 N0–1 M0). The median survival in this subgroup was 18.2 months, 3- and 5-year survival rates were 22.7% (21/102) and 15.0% (13/102), respectively.

Conclusion:

Despite being nominally inferior to platinum-based radiochemotherapy, the overall survival rates are in a similar range. Thus, the mitomycin-C-based radiochemotherapy approach may considered to be as effective as the standard therapy. However, there is no randomized trial available in order to prove the equality.

Hintergrund und Ziel:

Radiochemotherapie mit 5-Fluorouracil und Cisplatin gilt seit 2 Jahrzehnten als Standard fur die primare Behandlung des Osophaguskarzinoms. Im Gegensatz dazu erhielten die meisten Patienten, die im Klinikum der LMU Munchen behandelt wurden, eine definitive Radiochemotherapie mit 5-Fluorouracil und Mitomycin C. Retrospektiv wurde gepruft, zu welchen Ergebnissen das angewandte Regime im Vergleich zur Standardtherapie fuhrte.

Patienten und Methodik:

Retrospektiv wurden Tumorstadium, Therapieform und das Outcome der Patienten mit Osophaguskarzinom, die zwischen 1982 und 2007 behandelt wurden, erhoben (Tabelle 1). Primarer Endpunkt war das Gesamtuberleben (Abbildungen 1a bis 1c).

Ergebnisse:

298 Patienten (16,8% Adenokarzinome [50/298], 77,5% Plattenepithelkarzinome [231/298]) wurden primar behandelt. Bei Diagnosestellung wiesen 61,7% (184/298) UICC-Stadien III–IV, 54,4% (162/298) einen positiven Lymphknotenstatus sowie 26,5% (79/298) Fernmetastasen auf. 74,5% aller Patienten (222/298) erhielten eine Bestrahlungsdosis zwischen 55 und 65 Gy. 65,8% (196/298) bekamen parallel dazu eine Chemotherapie. Der mediane Nachbeobachtungszeitraum betrug 4,1 Jahre. Es zeigte sich ein signifikant langeres Uberleben in der Radiochemotherapiegruppe im Vergleich zur Radiotherapiegruppe (p < 0,0001). 102/196 Patienten (52%) in der Radiochemotherapiegruppe hatten Tumorstadium T1–3 N0–1 M0, entsprechend der RTOG-85-01-Kohorte. In dieser Subgruppe zeigten sich ein medianes Uberleben von 18,2 Monaten und Uberlebensraten von 22,7% (21/102) bzw. 15,0% (13/102) nach 3 respektive 5 Jahren (Tabellen 2 und 4).

Schlussfolgerung:

Obwohl in diesem unselektionierten Kollektiv der Standardtherapie mit Cisplatin/5-Fluorouracil nominell unterlegen, sind die Uberlebensraten in einem vergleichbaren Bereich (Tabelle 3). Eine Radiochemotherapie mit 5-Fluorouracil und Mitomycin C scheint ahnlich effektiv wie die Standardtherapie zu sein. Allerdings gibt es keine randomisierte Studie, um dies zu beweisen.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Munich, LMU, Munich, Germany

    Maria Wolf, Franz Zehentmayr, Maximilian Niyazi, Ute Ganswindt, Wolfgang Haimerl & Claus Belka

  2. Institute for Biometry and Epidemiology, University Hospital Munich, LMU, Munich, Germany

    Michael Schmidt

  3. Tumor Registry Munich, University Hospital Munich, LMU, Munich, Germany

    Dieter Hölzel

  4. Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Germany

    Maria Wolf

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  1. Maria Wolf
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Correspondence to Maria Wolf.

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*Parts of the data were presented (poster presentation) at the 15th Annual Meeting of the German Society of Radiation Oncology (DEGRO) in Bremen, June 11–14, 2009.

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Wolf, M., Zehentmayr, F., Niyazi, M. et al. Long-Term Outcome of Mitomycin C- and 5-FU-Based Primary Radiochemotherapy for Esophageal Cancer. Strahlenther Onkol 186, 374–381 (2010). https://doi.org/10.1007/s00066-010-2137-y

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  • DOI: https://doi.org/10.1007/s00066-010-2137-y

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