Selective dose escalation of chemoradiotherapy for locally advanced esophageal cancer

Steven K. Seung, J. W. Smith, Helen J Ross

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

This phase II study assessed the use of concurrent continuous infusion of 5-fluorouracil and weekly carboplatin plus paclitaxel with selective radiation dose escalation for patients with localized esophageal cancer. Patients with esophageal carcinoma were staged by thoracic and abdominal computed tomography, endoscopic ultrasound, and positron emission tomography scans. Patients received a continuous infusion of 5-fluorouracil 225 mg/m2 on days 1 to 38 and intravenous paclitaxel 45 mg/m2 and carboplatin AUC 2 on days 1, 8, 15, 22, 29, and 36. Radiotherapy was delivered in 1.8-Gy fractions, 5 d/wk for 5.5 weeks. Six to 8 weeks after initial therapy, patients without metastatic progression but with a positive biopsy, or less than partial response received a 9-Gy boost with the same concurrent chemotherapy. Twenty-four patients were enrolled: 18 patients were enrolled initially; 6 additional patients were enrolled following a protocol amendment designed to reduce the esophagitis by adding the radioprotectant amifostine. Median follow-up was 30 months. Twenty (83%) patients had adenocarcinomas of the lower esophagus/gastroesophageal junction. Seventeen patients (81%) attained at least a partial response. Six patients received boost treatment. At 4 years, overall survival was 28%, cause-specific survival was 38%, locoregional control was 61%, and distant metastasis-free survival was 52%. Radiation delays ranged from 0 to 62 days (median, 8d), primarily owing to esophagitis. In total, 28% of patients developed esophageal strictures requiring dilatations. There were no differences in esophageal strictures, local control, or survival with the addition of amifostine.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalDiseases of the Esophagus
Volume21
Issue number7
DOIs
StatePublished - 2008
Externally publishedYes

Fingerprint

Chemoradiotherapy
Esophageal Neoplasms
Amifostine
Esophageal Stenosis
Survival
Esophagitis
Carboplatin
Paclitaxel
Fluorouracil
Radiation
Esophagogastric Junction
Positron-Emission Tomography
Area Under Curve
Dilatation
Radiotherapy
Thorax
Tomography
Neoplasm Metastasis
Carcinoma
Biopsy

Keywords

  • Amifostine
  • Chemotherapy
  • Esophageal neoplasms
  • Radiotherapy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Selective dose escalation of chemoradiotherapy for locally advanced esophageal cancer. / Seung, Steven K.; Smith, J. W.; Ross, Helen J.

In: Diseases of the Esophagus, Vol. 21, No. 7, 2008, p. 589-595.

Research output: Contribution to journalArticle

@article{acf1dc5d61664234a506df7f2fb3fef4,
title = "Selective dose escalation of chemoradiotherapy for locally advanced esophageal cancer",
abstract = "This phase II study assessed the use of concurrent continuous infusion of 5-fluorouracil and weekly carboplatin plus paclitaxel with selective radiation dose escalation for patients with localized esophageal cancer. Patients with esophageal carcinoma were staged by thoracic and abdominal computed tomography, endoscopic ultrasound, and positron emission tomography scans. Patients received a continuous infusion of 5-fluorouracil 225 mg/m2 on days 1 to 38 and intravenous paclitaxel 45 mg/m2 and carboplatin AUC 2 on days 1, 8, 15, 22, 29, and 36. Radiotherapy was delivered in 1.8-Gy fractions, 5 d/wk for 5.5 weeks. Six to 8 weeks after initial therapy, patients without metastatic progression but with a positive biopsy, or less than partial response received a 9-Gy boost with the same concurrent chemotherapy. Twenty-four patients were enrolled: 18 patients were enrolled initially; 6 additional patients were enrolled following a protocol amendment designed to reduce the esophagitis by adding the radioprotectant amifostine. Median follow-up was 30 months. Twenty (83{\%}) patients had adenocarcinomas of the lower esophagus/gastroesophageal junction. Seventeen patients (81{\%}) attained at least a partial response. Six patients received boost treatment. At 4 years, overall survival was 28{\%}, cause-specific survival was 38{\%}, locoregional control was 61{\%}, and distant metastasis-free survival was 52{\%}. Radiation delays ranged from 0 to 62 days (median, 8d), primarily owing to esophagitis. In total, 28{\%} of patients developed esophageal strictures requiring dilatations. There were no differences in esophageal strictures, local control, or survival with the addition of amifostine.",
keywords = "Amifostine, Chemotherapy, Esophageal neoplasms, Radiotherapy",
author = "Seung, {Steven K.} and Smith, {J. W.} and Ross, {Helen J}",
year = "2008",
doi = "10.1111/j.1442-2050.2008.00822.x",
language = "English (US)",
volume = "21",
pages = "589--595",
journal = "Diseases of the Esophagus",
issn = "1120-8694",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Selective dose escalation of chemoradiotherapy for locally advanced esophageal cancer

AU - Seung, Steven K.

AU - Smith, J. W.

AU - Ross, Helen J

PY - 2008

Y1 - 2008

N2 - This phase II study assessed the use of concurrent continuous infusion of 5-fluorouracil and weekly carboplatin plus paclitaxel with selective radiation dose escalation for patients with localized esophageal cancer. Patients with esophageal carcinoma were staged by thoracic and abdominal computed tomography, endoscopic ultrasound, and positron emission tomography scans. Patients received a continuous infusion of 5-fluorouracil 225 mg/m2 on days 1 to 38 and intravenous paclitaxel 45 mg/m2 and carboplatin AUC 2 on days 1, 8, 15, 22, 29, and 36. Radiotherapy was delivered in 1.8-Gy fractions, 5 d/wk for 5.5 weeks. Six to 8 weeks after initial therapy, patients without metastatic progression but with a positive biopsy, or less than partial response received a 9-Gy boost with the same concurrent chemotherapy. Twenty-four patients were enrolled: 18 patients were enrolled initially; 6 additional patients were enrolled following a protocol amendment designed to reduce the esophagitis by adding the radioprotectant amifostine. Median follow-up was 30 months. Twenty (83%) patients had adenocarcinomas of the lower esophagus/gastroesophageal junction. Seventeen patients (81%) attained at least a partial response. Six patients received boost treatment. At 4 years, overall survival was 28%, cause-specific survival was 38%, locoregional control was 61%, and distant metastasis-free survival was 52%. Radiation delays ranged from 0 to 62 days (median, 8d), primarily owing to esophagitis. In total, 28% of patients developed esophageal strictures requiring dilatations. There were no differences in esophageal strictures, local control, or survival with the addition of amifostine.

AB - This phase II study assessed the use of concurrent continuous infusion of 5-fluorouracil and weekly carboplatin plus paclitaxel with selective radiation dose escalation for patients with localized esophageal cancer. Patients with esophageal carcinoma were staged by thoracic and abdominal computed tomography, endoscopic ultrasound, and positron emission tomography scans. Patients received a continuous infusion of 5-fluorouracil 225 mg/m2 on days 1 to 38 and intravenous paclitaxel 45 mg/m2 and carboplatin AUC 2 on days 1, 8, 15, 22, 29, and 36. Radiotherapy was delivered in 1.8-Gy fractions, 5 d/wk for 5.5 weeks. Six to 8 weeks after initial therapy, patients without metastatic progression but with a positive biopsy, or less than partial response received a 9-Gy boost with the same concurrent chemotherapy. Twenty-four patients were enrolled: 18 patients were enrolled initially; 6 additional patients were enrolled following a protocol amendment designed to reduce the esophagitis by adding the radioprotectant amifostine. Median follow-up was 30 months. Twenty (83%) patients had adenocarcinomas of the lower esophagus/gastroesophageal junction. Seventeen patients (81%) attained at least a partial response. Six patients received boost treatment. At 4 years, overall survival was 28%, cause-specific survival was 38%, locoregional control was 61%, and distant metastasis-free survival was 52%. Radiation delays ranged from 0 to 62 days (median, 8d), primarily owing to esophagitis. In total, 28% of patients developed esophageal strictures requiring dilatations. There were no differences in esophageal strictures, local control, or survival with the addition of amifostine.

KW - Amifostine

KW - Chemotherapy

KW - Esophageal neoplasms

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=53149132033&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=53149132033&partnerID=8YFLogxK

U2 - 10.1111/j.1442-2050.2008.00822.x

DO - 10.1111/j.1442-2050.2008.00822.x

M3 - Article

VL - 21

SP - 589

EP - 595

JO - Diseases of the Esophagus

JF - Diseases of the Esophagus

SN - 1120-8694

IS - 7

ER -