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Buckle GC, Mahapatra R, Mwachiro M, Akoko L, Mmbaga EJ, White RE, Bent S, Van Loon K. Optimal management of esophageal cancer in Africa: A systemic review of treatment strategies. Int J Cancer 2020; 148:1115-1131. [PMID: 32930395 DOI: 10.1002/ijc.33299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/05/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022]
Abstract
Esophageal cancer (EC) is a leading cause of cancer morbidity and mortality in Africa. Despite the high burden of disease, optimal management strategies for EC in resource-constrained settings have yet to be established. This systematic review evaluates the literature on treatments for EC throughout Africa and compares the efficacy and safety of varying treatment strategies in this context (PROSPERO CRD42017071546). PubMed, Embase and African Index Medicus were searched for studies published on treatment strategies for EC in Africa from 1980 to 2020. Searches were supplemented by examining bibliographies of included studies and relevant conference proceedings. Methodological quality/risk of bias was assessed using the Cochrane Risk-of-Bias tool and the Newcastle-Ottawa Scale. Forty-six studies were included. Case series constituted the majority of studies: 13 were case series reporting on outcomes of esophagectomies, 17 on palliative luminal or surgical interventions, four on radiotherapy and three on concurrent chemoradiation. Nine randomized controlled trials were identified, of which four prospectively compared different treatment modalities (one investigating radiotherapy vs chemoradiation, three evaluating rigid plastic stents vs other treatments). This review summarizes the research on EC treatments in Africa published over the last four decades and outlines critical gaps in knowledge related to management in this context. Areas in need of further research include (a) evaluation of the safety and efficacy of neoadjuvant therapy in patients with locally advanced disease; (b) strategies to improve long-term survival in patients treated with definitive chemoradiation; and (c) the comparative effectiveness of modern palliative interventions, focusing on quality of life and survival as outcome measures.
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Affiliation(s)
- Geoffrey C Buckle
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.,Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Ruchika Mahapatra
- Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | | | - Larry Akoko
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Russell E White
- Department of Surgery, Tenwek Hospital, Bomet, Kenya.,Department of Surgery, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Stephen Bent
- Division of General Internal Medicine, Department of Medicine, UCSF, San Francisco, California, USA
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.,Global Cancer Program, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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Thomas A, Virdee PS, Eatock M, Lord SR, Falk S, Anthoney DA, Turkington RC, Goff M, Elhussein L, Collins L, Love S, Moschandreas J, Middleton MR. Dual Erb B Inhibition in Oesophago-gastric Cancer (DEBIOC): A phase I dose escalating safety study and randomised dose expansion of AZD8931 in combination with oxaliplatin and capecitabine chemotherapy in patients with oesophagogastric adenocarcinoma. Eur J Cancer 2020; 124:131-141. [PMID: 31765988 PMCID: PMC6947485 DOI: 10.1016/j.ejca.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/07/2019] [Accepted: 10/13/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AZD8931 has equipotent activity against epidermal growth factor receptor, erbB2, and erbB3. Primary objectives were to determine the recommended phase II dose (RP2D) of AZD8931 + chemotherapy, and subsequently assess safety/preliminary clinical activity in patients with operable oesophagogastric cancer (OGC). METHODS AZD8931 (20 mg, 40 mg or 60 mg bd) was given with Xelox (oxaliplatin + capecitabine) for eight 21-day cycles, continuously or with intermittent schedule (4 days on/3 off every week; 14 days on/7 off, per cycle) in a rolling-six design. Subsequently, patients with OGC were randomised 2:1 to AZD8931 + Xelox at RP2D or Xelox only for two cycles, followed by radical oesophagogastric surgery. Secondary outcomes were safety, complete resection (R0) rate, six-month progression-free survival (PFS) and overall survival. RESULTS During escalation, four dose-limiting toxicities were observed among 24 patients: skin rash (1) and failure to deliver 100% of Xelox because of treatment-associated grade III-IV adverse events (AEs) (3: diarrhoea and vomiting; vomiting; fatigue). Serious adverse events (SAE) occurred in 15 of 24 (63%) patients. RP2D was 20-mg bd with the 4/3 schedule. In the expansion phase, 2 of 20 (10%) patients in the Xelox + AZD8931 group and 5/10 (50%) patients in the Xelox group had grade III-IV AEs. Six-month PFS was 85% (90% CI: 66%-94%) in Xelox + AZD8931 and 100% in Xelox alone. Seven deaths (35%) occurred with Xelox + AZD8931 and one (10%) with Xelox. R0 rate was 45% (9/20) with Xelox + AZD8931 and 90% (9/10) with Xelox-alone (P = 0.024). CONCLUSION Xelox + AZD8931 (20 mg bd 4/3 days) has an acceptable safety profile administered as neoadjuvant therapy in operable patients with OGC. (Trial registration: EudraCT 2011-003169-13, ISRCTN-68093791).
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Affiliation(s)
| | - Pradeep S Virdee
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | | | - Stephen Falk
- Bristol Haematology & Oncology Centre, Bristol, UK
| | | | - Richard C Turkington
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast, UK
| | - Matthew Goff
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Leena Elhussein
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Linda Collins
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Sharon Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Mark R Middleton
- University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, UK
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Asombang AW, Chishinga N, Nkhoma A, Chipaila J, Nsokolo B, Manda-Mapalo M, Montiero JFG, Banda L, Dua KS. Systematic review and meta-analysis of esophageal cancer in Africa: Epidemiology, risk factors, management and outcomes. World J Gastroenterol 2019; 25:4512-4533. [PMID: 31496629 PMCID: PMC6710188 DOI: 10.3748/wjg.v25.i31.4512] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal cancer (EC) is associated with a poor prognosis, particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease. AIM To provide further understanding of EC in the context of the unique cultural and genetic diversity, and socio-economic challenges faced on the African continent. METHODS We performed a systematic review of studies from Africa to obtain data on epidemiology, risk factors, management and outcomes of EC. A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer, and the Cancer in Sub-Saharan reports. We searched EMBASE, PubMed, Web of Science, and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved. Random effects meta-analyses were used to assess heterogeneity between studies and to obtain odds ratio (OR) of the associations between EC and risk factors; and incidence rate ratios for EC between sexes with their respective 95% confidence intervals (CI). RESULTS The incidence of EC is higher in males than females, except in North Africa where it is similar for both sexes. The highest age-standardized rate is from Malawi (30.3 and 19.4 cases/year/100000 population for males and females, respectively) followed by Kenya (28.7 cases/year/100000 population for both sexes). The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old. Meta-analysis shows a strong association with tobacco (OR 3.15, 95%CI: 2.83-3.50). There was significant heterogeneity between studies on alcohol consumption (OR 2.28, 95%CI: 1.94-2.65) and on low socioeconomic status (OR 139, 95%CI: 1.25-1.54) as risk factors, but these could also contribute to increasing the incidence of EC. The best treatment outcomes were with esophagectomy with survival rates of 76.6% at 3 years, and chemo-radiotherapy with an overall combined survival time of 267.50 d. CONCLUSION Africa has high incidence and mortality rates of EC, with preventable and non-modifiable risk factors. Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption. Management requires a multidisciplinary approach, and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy.
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Affiliation(s)
- Akwi W Asombang
- Division of Gastroenterology/Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Nathaniel Chishinga
- Department for HIV Elimination, Fulton County Government, Atlanta, GA 30303, United States
| | - Alick Nkhoma
- Department of Gastroenterology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire ST4 6QG, United Kingdom
| | - Jackson Chipaila
- Department of Surgery, University Teaching Hospital-Adult Hospital, Lusaka 10101, Zambia
| | - Bright Nsokolo
- Department of Medicine, Levy Mwanawasa University Teaching Hospital, Tropical Gastroenterology and Nutrition Group (TROPGAN), Lusaka 10101, Zambia
| | - Martha Manda-Mapalo
- Department of Medicine, The University of New Mexico, Albuquerque, NM 87106, United States
| | | | - Lewis Banda
- Hematology/Oncology, Cancer Disease Hospital, Lusaka 10101, Zambia
| | - Kulwinder S Dua
- Department of Medicine and Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Tomasello G, Ghidini M, Barni S, Passalacqua R, Petrelli F. Overview of different available chemotherapy regimens combined with radiotherapy for the neoadjuvant and definitive treatment of esophageal cancer. Expert Rev Clin Pharmacol 2017; 10:649-660. [PMID: 28349718 DOI: 10.1080/17512433.2017.1313112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Neoadjuvant chemoradiotherapy (CTRT) is the current standard of care for treatment of locally advanced cancer of the esophagus or gastroesophageal junction. Many efforts have been made over the last years to identify the best chemotherapy and radiotherapy combination regimen, but specific randomized trials addressing this issue are still lacking. Areas covered: A systematic review of the literature was performed searching in PubMed all published studies of combinations CTRT regimens for operable or unresectable esophageal cancer to describe activity and toxicity. Studies considered were prospective series or clinical phase II-III trials including at least 40 patients and published in English language. Expert commentary: Long-term results of CROSS trial have established RT combined with carboplatin plus paclitaxel chemotherapy as the preferred neoadjuvant treatment option for both squamous and adenocarcinoma of the esophagus. More effective multimodal treatment strategies integrating novel biological agents including immunotherapy and based on an extensive molecular tumor characterization are eagerly awaited.
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Affiliation(s)
- Gianluca Tomasello
- a Oncology Unit, Oncology Department , ASST Ospedale di Cremona , Cremona , Italy
| | - Michele Ghidini
- a Oncology Unit, Oncology Department , ASST Ospedale di Cremona , Cremona , Italy
| | - Sandro Barni
- b Oncology Unit, Oncology Department , ASST Bergamo Ovest , Treviglio (BG) , Italy
| | - Rodolfo Passalacqua
- a Oncology Unit, Oncology Department , ASST Ospedale di Cremona , Cremona , Italy
| | - Fausto Petrelli
- b Oncology Unit, Oncology Department , ASST Bergamo Ovest , Treviglio (BG) , Italy
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So B, Marcu L, Olver I, Gowda R, Bezak E. Oesophageal cancer: Which treatment is the easiest to swallow? A review of combined modality treatments for resectable carcinomas. Crit Rev Oncol Hematol 2017; 113:135-150. [PMID: 28427503 DOI: 10.1016/j.critrevonc.2017.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 12/17/2016] [Accepted: 03/08/2017] [Indexed: 01/31/2023] Open
Abstract
Oesophageal cancer is a relatively uncommon malignancy, but with poor prognosis. Despite several treatment options that are available, the 5-year survival rates rarely exceed 40%. This review discusses the main challenges of oesophageal cancer, the available treatment options, and the most effective treatment in terms of overall survival. The outcomes of clinical trials show that neo-adjuvant chemo-radiotherapy using cisplatin and 5-fluorouracil followed by oesophagectomy results in the greatest survival. However, the optimal chemotherapy and radiotherapy schedule remains unclear. There is no satisfactory treatment to date, particularly for patients with co-morbidities or advanced tumours.
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Affiliation(s)
- Bianca So
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Loredana Marcu
- Faculty of Science, University of Oradea, Oradea 410087, Romania; School of Physical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Ian Olver
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Eva Bezak
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia; School of Physical Sciences, University of Adelaide, Adelaide, SA, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia.
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Mukherjee S, Hurt CN, Gwynne S, Sebag-Montefiore D, Radhakrishna G, Gollins S, Hawkins M, Grabsch HI, Jones G, Falk S, Sharma R, Bateman A, Roy R, Ray R, Canham J, Griffiths G, Maughan T, Crosby T. NEOSCOPE: A randomised phase II study of induction chemotherapy followed by oxaliplatin/capecitabine or carboplatin/paclitaxel based pre-operative chemoradiation for resectable oesophageal adenocarcinoma. Eur J Cancer 2017; 74:38-46. [PMID: 28335886 PMCID: PMC5341738 DOI: 10.1016/j.ejca.2016.11.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/31/2016] [Accepted: 11/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Oxaliplatin-capecitabine (OxCap) and carboplatin-paclitaxel (CarPac) based neo-adjuvant chemoradiotherapy (nCRT) have shown promising activity in localised, resectable oesophageal cancer. PATIENTS AND METHODS A non-blinded, randomised (1:1 via a centralised computer system), 'pick a winner' phase II trial. Patients with resectable oesophageal adenocarcinoma ≥ cT3 and/or ≥ cN1 were randomised to OxCapRT (oxaliplatin 85 mg/m2 day 1, 15, 29; capecitabine 625 mg/m2 bd on days of radiotherapy) or CarPacRT (carboplatin AUC2; paclitaxel 50 mg/m2 day 1, 8, 15, 22, 29). Radiotherapy dose was 45 Gy/25 fractions/5 weeks. Both arms received induction OxCap chemotherapy (2 × 3 week cycles of oxaliplatin 130 mg/m2 day 1, capecitabine 625 mg/m2 bd days 1-21). Surgery was performed 6-8 weeks after nCRT. Primary end-point was pathological complete response (pCR). Secondary end-points included toxicity, surgical morbidity/mortality, resection rate and overall survival. STATISTICS Based on pCR ≤ 15% not warranting future investigation, but pCR ≥ 35% would, 76 patients (38/arm) gave 90% power (one-sided alpha 10%), implying that arm(s) having ≥10 pCR out of first 38 patients could be considered for phase III trials. ClinicalTrials.gov: NCT01843829. Funder: Cancer Research UK (C44694/A14614). RESULTS Eighty five patients were randomised between October 2013 and February 2015 from 17 UK centres. Three of 85 (3.5%) died during induction chemotherapy. Seventy-seven patients (OxCapRT = 36; CarPacRT = 41) underwent surgery. The 30-d post-operative mortality was 2/77 (2.6%). Grade III/IV toxicity was comparable between arms, although neutropenia was higher in the CarPacRT arm (21.4% versus 2.6%, p = 0.01). Twelve of 41 (29.3%) (10 of first 38 patients) and 4/36 (11.1%) achieved pCR in the CarPacRT and OxcapRT arms, respectively. Corresponding R0 resection rates were 33/41 (80.5%) and 26/36 (72.2%), respectively. CONCLUSION Both regimens were well tolerated. Only CarPacRT passed the predefined pCR criteria for further investigation.
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Affiliation(s)
- Somnath Mukherjee
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford, OX3 7DQ, UK.
| | - Christopher Nicholas Hurt
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Sarah Gwynne
- South West Wales Cancer Centre, Swansea, SA2 8QA, UK.
| | - David Sebag-Montefiore
- St James's Institute of Oncology, University of Leeds, Cancer Research UK Leeds Centre, St James's University Hospital, Leeds, LS9 7TF, UK.
| | - Ganesh Radhakrishna
- St James's Institute of Oncology, University of Leeds, Cancer Research UK Leeds Centre, St James's University Hospital, Leeds, LS9 7TF, UK.
| | - Simon Gollins
- North Wales Cancer Treatment Centre, Rhyl, LL18 5UJ, UK.
| | - Maria Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford, OX3 7DQ, UK.
| | - Heike I Grabsch
- GROW School for Oncology and Developmental Biology, Department of Pathology, Maastricht University Medical Centre, Maastricht, Netherlands; Section of Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, UK.
| | - Gareth Jones
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff, CF14 2TL, UK.
| | - Stephen Falk
- Bristol Haematology and Oncology Centre, Bristol, BS2 8ED, UK.
| | - Ricky Sharma
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford, OX3 7DQ, UK.
| | - Andrew Bateman
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Rajarshi Roy
- Diana Princess of Wales Hospital, Scartho Road, Grimsby, South Humberside, DN33 2BA, UK.
| | - Ruby Ray
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Jo Canham
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Tim Maughan
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford, OX3 7DQ, UK.
| | - Tom Crosby
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff, CF14 2TL, UK.
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Chang CH, Liu SY, Chi CW, Yu HL, Chang TJ, Tsai TH, Lee TW, Chen YJ. External beam radiotherapy synergizes ¹⁸⁸Re-liposome against human esophageal cancer xenograft and modulates ¹⁸⁸Re-liposome pharmacokinetics. Int J Nanomedicine 2015; 10:3641-9. [PMID: 26056445 PMCID: PMC4447003 DOI: 10.2147/ijn.s80302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
External beam radiotherapy (EBRT) treats gross tumors and local microscopic diseases. Radionuclide therapy by radioisotopes can eradicate tumors systemically. Rhenium 188 ((188)Re)-liposome, a nanoparticle undergoing clinical trials, emits gamma rays for imaging validation and beta rays for therapy, with biodistribution profiles preferential to tumors. We designed a combinatory treatment and examined its effects on human esophageal cancer xenografts, a malignancy with potential treatment resistance and poor prognosis. Human esophageal cancer cell lines BE-3 (adenocarcinoma) and CE81T/VGH (squamous cell carcinoma) were implanted and compared. The radiochemical purity of (188)Re-liposome exceeded 95%. Molecular imaging by NanoSPECT/CT showed that BE-3, but not CE81T/VGH, xenografts could uptake the (188)Re-liposome. The combination of EBRT and (188)Re-liposome inhibited tumor regrowth greater than each treatment alone, as the tumor growth inhibition rate was 30% with EBRT, 25% with (188)Re-liposome, and 53% with the combination treatment at 21 days postinjection. Combinatory treatment had no additive adverse effects and significant biological toxicities on white blood cell counts, body weight, or liver and renal functions. EBRT significantly enhanced the excretion of (188)Re-liposome into feces and urine. In conclusion, the combination of EBRT with (188)Re-liposome might be a potential treatment modality for esophageal cancer.
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Affiliation(s)
- Chih-Hsien Chang
- Isotope Application Division, Institute of Nuclear Energy Research, Taoyuan, Taiwan ; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Shin-Yi Liu
- Department of Medical Research MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Wen Chi
- Department of Medical Research MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsiang-Lin Yu
- Isotope Application Division, Institute of Nuclear Energy Research, Taoyuan, Taiwan
| | - Tsui-Jung Chang
- Isotope Application Division, Institute of Nuclear Energy Research, Taoyuan, Taiwan
| | - Tung-Hu Tsai
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Wei Lee
- Isotope Application Division, Institute of Nuclear Energy Research, Taoyuan, Taiwan
| | - Yu-Jen Chen
- Department of Medical Research MacKay Memorial Hospital, Taipei, Taiwan ; Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan ; Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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8
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Mukherjee S, Hurt CN, Gwynne S, Bateman A, Gollins S, Radhakrishna G, Hawkins M, Canham J, Lewis W, Grabsch HI, Sharma RA, Wade W, Maggs R, Tranter B, Roberts A, Sebag-Montefiore D, Maughan T, Griffiths G, Crosby T. NEOSCOPE: a randomised Phase II study of induction chemotherapy followed by either oxaliplatin/capecitabine or paclitaxel/carboplatin based chemoradiation as pre-operative regimen for resectable oesophageal adenocarcinoma. BMC Cancer 2015; 15:48. [PMID: 25880814 PMCID: PMC4329217 DOI: 10.1186/s12885-015-1062-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/30/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Both oxaliplatin/capecitabine-based chemoradiation (OXCAP-RT) and carboplatin-paclitaxel based radiation (CarPac-RT) are active regimens in oesophageal adenocarcinoma, but no randomised study has compared their efficacy and toxicity. This randomised phase II "pick a winner" trial will identify the optimum regimen to take forward to a future phase III trial against neo-adjuvant chemotherapy, the current standard in the UK. METHODS/DESIGN Patients with resectable adenocarcinoma of the oesophagus or Siewert Type 1-2 gastro-oesophageal junction (GOJ), ≥T3 and/or ≥ N1 are eligible for the study. Following two cycles of induction OXCAP chemotherapy (oxaliplatin 130 mg/m2 D1, Cape 625 mg/m(2) D1-21, q 3 wk), patients are randomised 1:1 to OXCAP-RT (oxaliplatin 85 mg/m(2) Day 1,15,29; capecitabine 625 mg/m(2) twice daily on days of RT; RT-45 Gy/25 fractions/5 weeks) or CarPac-RT (Carboplatin AUC2 and paclitaxel 50 mg/m2 Day 1,8,15,22,29; RT-45 Gy/25 fractions/5 weeks). Restaging CT/PET-CT is performed 4-6 weeks after CRT, and a two-phase oesophagectomy with two-field lymphadenectomy is performed six to eight weeks after CRT. The primary end-point is pathological complete response rate (pCR) at resection and will include central review. Secondary endpoints include: recruitment rate, toxicity, 30-day surgical morbidity/mortality, resection margin positivity rate and overall survival (median, 3- and 5-yr OS. 76 patients (38/arm) gives 90% power and one-sided type 1 error of 10% if patients on one novel treatment have a response rate of 35% while the second treatment has a response rate of 15%. A detailed RT Quality Assurance (RTQA) programme includes a detailed RT protocol and guidance document, pre-accrual RT workshop, outlining exercise, and central evaluation of contouring and planning. This trial has been funded by Cancer Research UK (C44694/A14614), sponsored by Velindre NHS Trust and conducted through the Wales Cancer Trials Unit at Cardiff University on behalf of the NCRI Upper GI CSG. DISCUSSION Following encouraging results from previous trials, there is an interest in neo-adjuvant chemotherapy and CRT containing regimens for treatment of oesophageal adenocarcinoma. NEOSCOPE will first establish the efficacy, safety and feasibility of two different neo-adjuvant CRT regimens prior to a potential phase III trial. TRIAL REGISTRATION Eudract No: 2012-000640-10. ClinicalTrials.gov: NCT01843829 .
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Affiliation(s)
- Somnath Mukherjee
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK.
| | - Christopher N Hurt
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
| | | | - Andrew Bateman
- Cancer Care, University Hospital Southampton, Southampton, UK.
| | - Simon Gollins
- Department of Clinical Oncology, North Wales Cancer Treatment Centre, Rhyl, UK.
| | | | - Maria Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK.
| | - Jo Canham
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK.
| | - Wyn Lewis
- University Hospital of Wales, Cardiff and Vale NHS Trust, Cardiff, UK.
| | - Heike I Grabsch
- Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Ricky A Sharma
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK.
| | - Wendy Wade
- NISCHR CRC South East Wales Research Network, Cardiff, UK.
| | - Rhydian Maggs
- Cardiff NCRI RTTQA group, Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK.
| | - Bethan Tranter
- Velindre Cancer Centre, Velindre NHS Trust, Cardiff, UK.
| | - Ashley Roberts
- Velindre Cancer Centre, Velindre NHS Trust, Cardiff, UK.
| | - David Sebag-Montefiore
- University of Leeds, Cancer Research UK Leeds Centre, St James's University Hospital, Leeds, UK.
| | - Timothy Maughan
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, University of Oxford, Old Road Campus Research Building, Oxford, UK.
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, Faculty of Medicine, Southampton University, Southampton General Hospital, Southampton, UK.
| | - Tom Crosby
- Velindre Cancer Centre, Velindre NHS Trust, Cardiff, UK.
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9
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Tai P, Yu E. Esophageal cancer management controversies: Radiation oncology point of view. World J Gastrointest Oncol 2014; 6:263-274. [PMID: 25132924 PMCID: PMC4133794 DOI: 10.4251/wjgo.v6.i8.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/21/2014] [Accepted: 06/03/2014] [Indexed: 02/05/2023] Open
Abstract
Esophageal cancer treatment has evolved from single modality to trimodality therapy. There are some controversies of the role, target volumes and dose of radiotherapy (RT) in the literature over decades. The present review focuses primarily on RT as part of the treatment modalities, and highlight on the RT volume and its dose in the management of esophageal cancer. The randomized adjuvant chemoradiation (CRT) trial, intergroup trial (INT 0116) enrolled 559 patients with resected adenocarcinoma of the stomach or gastroesophageal junction. They were randomly assigned to surgery plus postoperative CRT or surgery alone. Analyses show robust treatment benefit of adjuvant CRT in most subsets for postoperative CRT. The Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) used a lower RT dose of 41.4 Gray in 23 fractions with newer chemotherapeutic agents carboplatin and paclitaxel to achieve an excellent result. Target volume of external beam radiation therapy and its coverage have been in debate for years among radiation oncologists. Pre-operative and post-operative target volumes are designed to optimize for disease control. Esophageal brachytherapy is effective in the palliation of dysphagia, but should not be given concomitantly with chemotherapy or external beam RT. The role of brachytherapy in multimodality management requires further investigation. On-going studies of multidisciplinary treatment in locally advanced cancer include: ZTOG1201 trial (a phase II trial of neoadjuvant and adjuvant CRT) and QUINTETT (a phase III trial of neoadjuvant vs adjuvant therapy with quality of life analysis). These trials hopefully will shed more light on the future management of esophageal cancer.
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Orditura M, Galizia G, Di Martino N, Ancona E, Castoro C, Pacelli R, Morgillo F, Rossetti S, Gambardella V, Farella A, Laterza MM, Ruol A, Fabozzi A, Napolitano V, Iovino F, Lieto E, Fei L, Conzo G, Ciardiello F, De Vita F. Effect of preoperative chemoradiotherapy on outcome of patients with locally advanced esophagogastric junction adenocarcinoma-a pilot study. ACTA ACUST UNITED AC 2014; 21:125-33. [PMID: 24940093 DOI: 10.3747/co.21.1570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND To date, few studies of preoperative chemotherapy or chemoradiotherapy (crt) in gastroesophageal junction (gej) cancer have been statistically powered; indeed, gej tumours have thus far been grouped with esophageal or gastric cancer in phase iii trials, thereby generating conflicting results. METHODS We studied 41 patients affected by locally advanced Siewert type i and ii gej adenocarcinoma who were treated with a neoadjuvant crt regimen [folfox4 (leucovorin-5-fluorouracil-oxaliplatin) for 4 cycles, and concurrent computed tomography-based three-dimensional conformal radiotherapy delivered using 5 daily fractions of 1.8 Gy per week for a total dose of 45 Gy], followed by surgery. Completeness of tumour resection (performed approximately 6 weeks after completion of crt), clinical and pathologic response rates, and safety and outcome of the treatment were the main endpoints of the study. RESULTS All 41 patients completed preoperative treatment. Combined therapy was well tolerated, with no treatment-related deaths. Dose reduction was necessary in 8 patients (19.5%). After crt, 78% of the patients showed a partial clinical response, 17% were stable, and 5% experienced disease progression. Pathology examination of surgical specimens demonstrated a 10% complete response rate. The median and mean survival times were 26 and 36 months respectively (95% confidence interval: 14 to 37 months and 30 to 41 months respectively). On multivariate analysis, TNM staging and clinical response were demonstrated to be the only independent variables related to long-term survival. CONCLUSIONS In our experience, preoperative chemoradiotherapy with folfox4 is feasible in locally advanced gej adenocarcinoma, but shows mild efficacy, as suggested by the low rate of pathologic complete response.
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Affiliation(s)
- M Orditura
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - G Galizia
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - N Di Martino
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - E Ancona
- Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy
| | - C Castoro
- Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy
| | - R Pacelli
- Division of Radiotherapy, Federico ii University of Naples School of Medicine, Naples, Italy
| | - F Morgillo
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - S Rossetti
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - V Gambardella
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - A Farella
- Division of Radiotherapy, Federico ii University of Naples School of Medicine, Naples, Italy
| | - M M Laterza
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - A Ruol
- Division of General Surgery 1, University of Padua, School of Medicine, Padua, Italy
| | - A Fabozzi
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - V Napolitano
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - F Iovino
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - E Lieto
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - L Fei
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - G Conzo
- Divisions of Surgical Oncology, Department of Anesthesiologic, Surgical, and Emergency Sciences, Second University of Naples School of Medicine, Naples, Italy
| | - F Ciardiello
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
| | - F De Vita
- Division of Medical Oncology, Department of Clinical and Experimental Medicine and Surgery, Second University of Naples School of Medicine, Naples, Italy
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Xu XT, Dai ZH, Xu Q, Qiao YQ, Gu Y, Nie F, Zhu MM, Tong JL, Ran ZH. Safety and efficacy of calcium and magnesium infusions in the chemoprevention of oxaliplatin-induced sensory neuropathy in gastrointestinal cancers. J Dig Dis 2013; 14:288-98. [PMID: 23432969 DOI: 10.1111/1751-2980.12050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To derive a more precise estimation on the safety and efficacy of calcium and magnesium (Ca and Mg) infusions in the prevention of oxaliplatin-induced sensory neuropathy. METHODS A total of 16 studies including 1765 individuals were involved in this meta-analysis. Odds ratio (OR) and its 95% confidence interval (CI) were calculated. RESULTS The difference in the incidence of oxaliplatin-induced neuropathy grade ≥ 1 was statistically significant between the Ca and Mg infusions treatment group and the untreated group (National Cancer Institute common toxicity criteria [NCI CTC]: OR 0.44, 95% CI 0.31-0.62, P = 0.000; oxaliplatin-specific scale [OSS]: OR 0.30, 95% CI 0.20-0.45, P = 0.000). Similar results were found in the incidences of oxaliplatin-induced neuropathy grade ≥ 2 (NCI CTC: OR 0.60, 95% CI 0.46-0.77, P = 0.000; OSS: OR 0.45, 95% CI 0.30-0.67, P = 0.000). However, we did not detect a trend of fewer oxaliplatin-induced neuropathy grade ≥ 3 incidences in the Ca and Mg infusions treatment group than the untreated group (NCI CTC: OR 0.67, 95% CI 0.44-1.01, P = 0.054; OSS: OR 0.66, 95% CI 0.34-1.29, P = 0.224). There was no difference in the response rate between the Ca and Mg treated group and the untreated group (OR 0.89, 95% CI 0.67-1.17, P = 0.391). CONCLUSION Ca and Mg infusions do not alter the efficacy of oxaliplatin-based chemotherapy in gastrointestinal cancers, which may be reasonable to add them to lessen the incidence of neuropathy.
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Affiliation(s)
- Xi Tao Xu
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Disease, Shanghai, China
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