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Pape M, Veen LM, Smit TM, Kuijper SC, Vissers PAJ, Geijsen ED, van Rossum PSN, Sprangers MAG, Derks S, Verhoeven RHA, van Laarhoven HWM. Late Toxicity and Health-Related Quality of Life Following Definitive Chemoradiotherapy for Esophageal Cancer: A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys 2023; 117:31-44. [PMID: 37224927 DOI: 10.1016/j.ijrobp.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/20/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Definitive chemoradiotherapy (dCRT) is a treatment option with curative intent for patients with esophageal cancer that could result in late toxicities and affect health-related quality of life (HRQoL). This study aimed to review the literature and perform a meta-analysis to investigate the effect of dCRT on late toxicities and HRQoL in esophageal cancer. METHODS AND MATERIALS A systematic search was performed in MEDLINE, EMBASE, and PsychINFO. Prospective phase II and III clinical trials, population-based studies, and retrospective chart reviews investigating late toxicity or HRQoL after dCRT (≥50 Gy) were included. The HRQoL outcomes were analyzed using linear mixed-effect models with restricted cubic spline transformation. Any HRQoL changes of ≥10 points were considered clinically relevant. The risk of toxicities was calculated using the number of events and the total study population. RESULTS Among 41 included studies, 10 assessed HRQoL and 31 late toxicity. Global health status remained stable over time and improved after 36 months compared with baseline (mean change, +11). Several tumor-specific symptoms, including dysphagia, eating restrictions, and pain, improved after 6 months compared with baseline. Compared with baseline, dyspnea worsened after 6 months (mean change, +16 points). The risk of any late toxicity was 48% (95% CI, 33%-64%). Late toxicity risk of any grade for the esophagus was 17% (95% CI, 12%-21%), pulmonary 21% (95% CI, 11%-31%), cardiac 12% (95% CI, 6%-17%), and any other organ 24% (95% CI, 2%-45%). CONCLUSIONS Global health status remained stable over time, and tumor-specific symptoms improved within 6 months after dCRT compared with baseline, with the exception of dyspnea. In addition, substantial risks of late toxicity were observed.
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Affiliation(s)
- Marieke Pape
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Linde M Veen
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Thom M Smit
- Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Steven C Kuijper
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands
| | - Pauline A J Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Elisabeth D Geijsen
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Peter S N van Rossum
- Amsterdam UMC location University of Amsterdam, Radiation Oncology, Amsterdam, the Netherlands
| | - Mirjam A G Sprangers
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Psychology, Amsterdam, the Netherlands
| | - Sarah Derks
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands; Oncode Institute, Utrecht, the Netherlands
| | - Rob H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Hanneke W M van Laarhoven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands
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Xu Z, Ke H, Zheng B, Lin C, Zhang Y, Wang L, Lin Y, Ye Y, Cai L, You M, Chen J, Xu Y. The Prognostic Significance of Nomogram-Based Pretreatment Inflammatory Indicators in Patients With Esophageal Squamous Cell Carcinoma Receiving Intensity-Modulated Radiotherapy. Cancer Control 2023; 30:10732748231185025. [PMID: 37339928 DOI: 10.1177/10732748231185025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND At present, there is no objective prognostic index available for patients with esophageal squamous cell carcinoma (ESCC) who underwent intensity-modulated radiotherapy (IMRT). This study is to develop a nomogram based on hematologic inflammatory indices for ESCC patients treated with IMRT. METHODS 581 patients with ESCC receiving definitive IMRT were enrolled in our retrospective study. Of which, 434 patients with treatment-naïve ESCC in Fujian Cancer Hospital were defined as the training cohort. Additional 147 newly diagnosed ESCC patients were used as the validation cohort. Independent predictors of overall survival (OS) were employed to establish a nomogram model. The predictive ability was evaluated by time-dependent receiver operating characteristic curves, the concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI). Decision curve analysis (DCA) was performed to assess the clinical benefits of the nomogram model. The entire series was divided into 3 risk subgroups stratified by the total nomogram scores. RESULTS Clinical TNM staging, primary gross tumor volume, chemotherapy, neutrophil-to-lymphocyte ratio and platelet lymphocyte ratio were independent predictors of OS. Nomogram was developed incorporating these factors. Compared with the 8th American Joint Committee on Cancer (AJCC) staging, the C-index for 5-year OS (.627 and .629) and the AUC value of 5-year OS (.706 and .719) in the training and validation cohorts (respectively) were superior. Furthermore, the nomogram model presented higher NRI and IDI. DCA also demonstrated that the nomogram model provided greater clinical benefit. Finally, patients with <84.8, 84.8-151.4, and >151.4 points were categorized into low-risk, intermediate-risk, and high-risk groups. Their 5-year OS rates were 44.0%, 23.6%, and 8.9%, respectively. The C-index was .625, which was higher than the 8th AJCC staging. CONCLUSIONS We have developed a nomogram model that enables risk-stratification of patients with ESCC receiving definitive IMRT. Our findings may serve as a reference for personalized treatment.
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Affiliation(s)
- Zhiyang Xu
- Department of Thoracic Surgery, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian, Putian, China
| | - Hongqian Ke
- Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Binglin Zheng
- Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Chuyan Lin
- Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Yiping Zhang
- Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Liyan Wang
- Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Yu Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yuling Ye
- Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Lifang Cai
- Department of Medical Oncology, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian, Putian, China
| | - Mengxing You
- Department of Medical Oncology, The School of Clinical Medicine, Fujian Medical University, The First Hospital of Putian, Putian, China
| | - Junqiang Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Yuanji Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Yi Q, Liu C, Cui Y, Yang Y, Li Y, Fan X, Wu K. Chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma: A retrospective analysis. Cancer Med 2022; 12:6477-6487. [PMID: 37012831 PMCID: PMC10067117 DOI: 10.1002/cam4.5416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/06/2022] [Accepted: 10/23/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This single-center retrospective clinical study aimed to evaluate the efficacy and feasibility of chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma (ESCC). METHODS Patients with locally advanced ESCC treated with paclitaxel-liposome-based chemoradiotherapy between 2016 and 2019 were retrospectively analyzed. Overall survival (OS) and progression-free survival (PFS) were evaluated using Kaplan-Meier analysis. RESULTS Thirty-nine patients with locally advanced ESCC were included in this study. The median follow-up time was 31.5 months. The median OS time was 38.3 (95% confidence interval [CI]: 32.1-45.1) months, and the 1-, 2-, and 3-year OS rates were 84.6%, 64.1%, and 56.2%, respectively. The median PFS time was 32.1 (95% CI: 25.4-39.0) months, and the 1-, 2-, and 3-year PFS rates were 71.8%, 43.6%, and 43.6%, respectively. The most common Grade IV toxicity was neutropenia (30.8%) followed by lymphopenia (20.5%). There were no cases of Grade III/IV radiation pneumonia, and four patients (10.3%) had Grade III/IV esophagitis. CONCLUSION Chemoradiotherapy using paclitaxel liposome and cisplatin is a well-tolerated and effective treatment regimen for locally advanced ESCC.
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Affiliation(s)
- Qiong Yi
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Radiation Oncology Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University Nantong China
| | - Canyu Liu
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Radiation Oncology Suzhou Dushu Lake Hospital, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University Suzhou China
| | - Yingshan Cui
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Radiation Oncology Jinhua Hospital, Zhejiang University School of Medicine, Jinhua Municipal Central Hospital Zhejiang China
| | - Yanguang Yang
- Department of Radiation Oncology Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University Nantong China
| | - Yaqi Li
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
| | - Xingwen Fan
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
- Shanghai Clinical Research Center for Radiation Oncology Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
| | - Kailiang Wu
- Department of Radiation Oncology Fudan University Shanghai Cancer Center Shanghai China
- Department of Oncology Shanghai Medical College, Fudan University Shanghai China
- Shanghai Clinical Research Center for Radiation Oncology Shanghai China
- Shanghai Key Laboratory of Radiation Oncology Shanghai China
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Hutten RJ, Weil CR, Gaffney DK, Kokeny K, Lloyd S, Rogers CR, Suneja G. Racial and Ethnic Health Disparities in Delay to Initiation of Intensity-Modulated Radiotherapy. JCO Oncol Pract 2022; 18:e1694-e1703. [PMID: 35930751 PMCID: PMC9663141 DOI: 10.1200/op.22.00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/01/2022] [Accepted: 06/22/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Delays in initiation of radiotherapy may contribute to inferior oncologic outcomes that are more commonly observed in minoritized populations in the United States. We aimed to examine inequities associated with delayed initiation of intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS The National Cancer Database was queried to identify the 10 cancer sites most commonly treated with IMRT. Interval to initiation of treatment (IIT) was broken into quartiles for each disease site, with the 4th quartile classified as delayed. Multivariable logistic regression for delayed IIT was performed for each disease site using clinical and demographic covariates. Differences in magnitude of delay between subsets of patients stratified by race and insurance status were evaluated using two-sample t-tests. RESULTS Among patients (n = 350,425) treated with IMRT between 2004 and 2017, non-Hispanic Black (NHB), Hispanic, and Asian patients were significantly more likely to have delayed IIT with IMRT for nearly all disease sites compared with non-Hispanic White (NHW) patients. NHB, Hispanic, and Asian patients had significantly longer median IIT than NHW patients (NHB 87 days, P < .01; Hispanic 76 days, P < .01; Asian 74 days, P < .01; and NHW 67 days). NHW, Hispanic, and Asian patients with private insurance had shorter median IIT than those with Medicare (P < .01); however, NHB patients with private insurance had longer IIT than those with Medicare (P < .01). CONCLUSION Delays in initiation of IMRT in NHB, Hispanic, and Asian patients may contribute to the known differences in cancer outcomes and warrant further investigation, particularly to further clarify the role of different insurance policies in delays in advanced modality radiotherapy.
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Affiliation(s)
- Ryan J. Hutten
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Christopher R. Weil
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - David K. Gaffney
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Kristine Kokeny
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - Charles R. Rogers
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
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Xiang M, Liu B, Zhang G, Gong H, Han D, Ma C. Induction Chemotherapy Followed by Chemoradiotherapy With or Without Consolidation Chemotherapy Versus Chemoradiotherapy Followed by Consolidation Chemotherapy for Esophageal Squamous Cell Carcinoma. Front Oncol 2022; 12:813021. [PMID: 35677167 PMCID: PMC9168112 DOI: 10.3389/fonc.2022.813021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/21/2022] [Indexed: 12/24/2022] Open
Abstract
ObjectiveThis study aimed to compare the efficacy and safety of induction chemotherapy followed by concurrent chemoradiotherapy (I-CCRT), induction chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy (I-CCRT-C), and concurrent chemoradiotherapy followed by consolidation chemotherapy (CCRT-C) for locally advanced esophageal squamous cell carcinoma (ESSC).Patients and MethodsPatients with locally advanced ESCC who underwent definitive chemoradiotherapy with cisplatin plus fluorouracil or docetaxel from February 2012 to December 2018 were retrospectively reviewed. Kaplan–Meier curve was used to estimate survival. Efficacy was assessed using RECIST, version 1.0. Prognosis factors were identified with Cox regression analysis.ResultsPatients were treated with CCRT-C (n = 59), I-CCRT (n = 20), and I-CCRT-C (n = 48). The median follow-up duration was 73.9 months for the entire cohort. The ORR of the CCRT-C, I-CCRT, and I-CCRT-C groups was 89.8%, 70.0%, and 77.1%, respectively (p = 0.078). The median PFS in the CCRT-C, I-CCRT, and I-CCRT-C groups was 32.5, 16.1, and 27.1 months, respectively (p = 0.464). The median OS of the CCRT-C, I-CCRT, and I-CCRT-C groups was 45.9, 35.5, and 54.0 months, respectively (p = 0.788). Cox regression analysis indicated that I-CCRT-C and I-CCRT did not significantly prolong PFS and OS compared with CCRT-C (p > 0.05). Neutropenia grade ≥3 in CCRT-C, I-CCRT, and I-CCRT-C groups was 47.5%, 15%, and 33.3% of patients, respectively (p = 0.027).ConclusionsI-CCRT and I-CCRT-C using cisplatin plus fluorouracil or docetaxel regimen are not superior to CCRT-C in survival but seem to have less severe neutropenia than CCRT-C. Further randomized controlled studies are warranted.
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Affiliation(s)
- Mingyue Xiang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Taian, China
| | - Bo Liu
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guifang Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Heyi Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Dali Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Dali Han, ; Changsheng Ma,
| | - Changsheng Ma
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Dali Han, ; Changsheng Ma,
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Characterization of self-aggregated mitomycin C onto the boron-nitride nanotube as a drug delivery carrier: A molecular dynamics investigation. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2021.116065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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7
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Deng L, Wu X, Zhu X, Yu Z, Liu Z, Wang J, Zheng Y. Combination effect of curcumin with docetaxel on the PI3K/AKT/mTOR pathway to induce autophagy and apoptosis in esophageal squamous cell carcinoma. Am J Transl Res 2021; 13:57-72. [PMID: 33527008 PMCID: PMC7847521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Docetaxel (DTX) is widely used to treat many malignant tumors but has many adverse effects. Curcumin (CUR) also has effects on a variety of tumor cells and can reduce the toxicity and side effects of chemotherapy drugs and the occurrence of drug resistance. However, the combination of CUR and DTX for treating esophageal cancer has not been reported. METHODS Human esophageal squamous cell carcinoma (ESCC) KYSE150 and KYSE510 cells were treated with CUR or DTX alone or both drugs and cancer cell viability was detected by CCK8, apoptosis, scratch-healing and migration assays. Electron microscopy and Western blots were used. In vivo experiments were used observe anti-tumor effects. RESULTS CUR combined with DTX significantly inhibited the viability and migration of esophageal cancer cells (P<0.01) and further promoted the apoptosis of cancer cells. In addition, CUR induced autophagy in esophageal cancer cells when combined with DTX. DTX combined with CUR may induce apoptosis and autophagy by inhibiting the PI3K/AKT/mTOR signaling pathway. The compound 3-methyladenine (3MA) inhibited the autophagy induced by DTX and CUR (DC), further accelerated apoptosis and inhibited the proliferation of esophageal cancer cells when combined with DC. CONCLUSION CUR combined with DTX induced apoptosis and autophagy of ESCC and probably worked through the PI3K/AKT/mTOR signaling pathway. The combination of the autophagy inhibitor, CUR and DTX may become a new treatment strategy for esophageal cancer.
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Affiliation(s)
- Lian Deng
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
- Second Department of Oncology, Guilin Nanxishan HospitalGuangxi, China
| | - Xiaoran Wu
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
| | - Xiongjie Zhu
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
| | - Zhongjian Yu
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
| | - Zhile Liu
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
| | - Jinting Wang
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
| | - Yanfang Zheng
- Department of Oncology, Zhujiang Hospital, Southern Medical University/The Second School of Clinical Medicine, Southern Medical UniversityGuangzhou, China
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Fan XW, Wang HB, Mao JF, Li L, Wu KL. Sequential boost of intensity-modulated radiotherapy with chemotherapy for inoperable esophageal squamous cell carcinoma: A prospective phase II study. Cancer Med 2020; 9:2812-2819. [PMID: 32100452 PMCID: PMC7163105 DOI: 10.1002/cam4.2933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/17/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose This prospective phase II study aimed to determine the efficacy and tolerability of sequential boost of intensity‐modulated radiation therapy (IMRT) with chemotherapy for patients with inoperable esophageal squamous cell carcinoma (ESCC). Methods Patients with histologically or cytologically proven inoperable ESCC were enrolled in this study (ChiCTR‐OIC‐17010485). A larger target volume for subclinical lesion was irradiated with 50 Gy, and then, a smaller target volume only including gross tumor was boosted to 66 Gy. The fraction dose was 2 Gy, and no elective node was irradiated. Concurrent and consolidation chemotherapy of fluorouracil (600 mg/m2, days 1‐3) plus cisplatin (25 mg/m2, days 1‐3) was administered every 4 weeks, for 4 cycles in total. The primary endpoint was 2‐year progression‐free survival (PFS). Results Eighty‐eight patients were enrolled in this study. The median age was 65 years (range: 45‐75 years), and 69 patients (78.4%) were men. With the median follow‐up of 26 (range: 3‐95) months, the 2‐ and 5‐year PFS were 39.3% and 36.9%, respectively, and overall survival (OS) were 57.1% and 39.2%, respectively. Tumor stage and concurrent chemotherapy were independent OS predictors. Major acute adverse events were myelosuppression and esophagitis, most of which were grades 1‐2. Nine percent and 2.3% of patients had grade 3 acute esophagitis and late esophageal strictures, respectively. Conclusions Sequential boost to 66 Gy by IMRT with chemotherapy was safe and effective for inoperable ESCC. A randomized phase III study to compare with standard dose of 50 Gy is warranted.
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Affiliation(s)
- Xing-Wen Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong-Bing Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing-Fang Mao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ling Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kai-Liang Wu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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