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Meng X, Wang L, Zhao Y, Zhu B, Sun T, Zhang T, Gu X, Zheng Z. Neoadjuvant Chemoradiation Treatment for Resectable Esophago-Gastric Cancer: A Systematic Review and Meta-Analysis. J Cancer 2019; 10:192-204. [PMID: 30662540 PMCID: PMC6329872 DOI: 10.7150/jca.25915] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/27/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Neoadjuvant chemoradiation (CRT) remains controversial in the treatment of the oesophagus or gastro-oesophageal junction (GOJ) carcinomas. Methods: We conducted a meta-analysis to assess the efficacy and safety of Neoadjuvant CRT plus surgery comparing with neoadjuvant CT plus surgery or surgery alone. Feasible studies were searched from electronic databases. The outcomes of survival, R0 resection rate and adverse effects were analyzed. The outcomes were measured with relative risk (RR) and odds ratio(OR). Results: Seventeen records including 4095 patients were included. Neoadjuvant CRT improved 1-,2-,3-and 5-year survival. The relative risk (RR) [95% confidence interval (CI),P value] was respectively 1.08(1.03-1.14,0.002), 1.21(1.12-1.32,<0.00001),1.31(1.09-1.58,0.004),1.38(1.17-1.62, <0.001).In subgroup analysis, patients with squamous cell carcinoma benefited more survival advantage from neoadjuvant CRT than those with adenocarcinoma[1.23(1.15-1.33)vs1.11 (1.03-1.19)]. A significant advantage was observed in analysis of neoadjuvant CRT for PFS [1.32 (1.22-1.44),<0.00001]. Tests for DFS between neoadjuvant CRT and neoadjuvant CT or surgery alone were not statistically significant[1.06 (0.97-1.17,0.19)]. Neoadjuvant CRT was associated with higher R0 resection [2.58(1.75-3.82),<0.00001] and pCR rate [4.37(2.68-7.13),<0.00001]. Neoadjuvant CRT lowered the local recurrence rate [0.52(0.39-0.69),<0.00001] and didn't control distant metastasis rate[0.85(0.67-1.08),0.19].There was no evidence that neoadjuvant CRT increased the treatment-related mortality[1.27(0.95-1.71),0.11]. Neoadjuvant CRT plus surgery did not increase the risk of adverse events morbidity[1.14(0.99-1.32),0.08]. Conclusion: Patients with oesophagus or GOJ carcinomas can obtain a survival advantage from neoadjuvant CRT. The addition of radiation was efficacy and safe in range. However, these results need further high-quality prospective RCTs confirmation.
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Affiliation(s)
- Xiangyu Meng
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Lu Wang
- Department of Ultrasonography, the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yan Zhao
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Bo Zhu
- Department of Information Management, the Information Center, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Ting Sun
- Department of Information Management, the Information Center, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Tao Zhang
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Xiaohu Gu
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
| | - Zhichao Zheng
- Department of Gastric Surgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital, Shenyang, Liaoning, China
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Fu T, Bu ZD, Li ZY, Zhang LH, Wu XJ, Wu AW, Shan F, Ji X, Dong QS, Ji JF. Neoadjuvant chemoradiation therapy for resectable esophago-gastric adenocarcinoma: a meta-analysis of randomized clinical trials. BMC Cancer 2015; 15:322. [PMID: 25928286 PMCID: PMC4415228 DOI: 10.1186/s12885-015-1341-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022] Open
Abstract
Background The efficacy and safety of preoperative chemoradiation therapy (CRT) for advanced esophago-gastric adenocarcinoma are still in question, and the prognosis of these patients is poor. Methods We systematically searched electronic databases from January 1990 to July 2014. The primary outcome was overall survival. The secondary outcomes were a R0 resection rate, positive rate of lymph node metastasis, postoperative recurrence rate, pathological complete response (pCR) rate and perioperative mortality. Overall survival was measured with a hazard ratio (HR), while other secondary outcomes were measured with an odds ratio (OR). Results Seven randomized controlled trials (RCTs) including 1085 patients were searched and, of these, 869 had adenocarcinoma. Patients receiving preoperative CRT had a longer overall survival (HR 0.74; 95% confidence interval (CI) 0.63–0.88), higher likelihood of R0 resection and greater chance of pCR, while they had a lower likelihood of lymph node metastasis and postoperative recurrence. The difference of perioperative mortality was non-significant. In addition, the result of the comparison between preoperative CRT and preoperative chemotherapy (CT) in two RCTs was non-significant. Conclusion Patients with resectable esophago-gastric adenocarcinoma can gain a survival advantage from preoperative CRT. However, limited to the number of RCTs, the effect of adding radiotherapy to preoperative CT separately is still uncertain and more high-quality prospective trials are needed.
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Affiliation(s)
- Tao Fu
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Zhao-De Bu
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Zi-Yu Li
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Lian-Hai Zhang
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Xiao-Jiang Wu
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Ai-Wen Wu
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Fei Shan
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Xin Ji
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Qiu-Shi Dong
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
| | - Jia-Fu Ji
- Department of gastrointestinal surgery, Peking University Cancer Hospital & Institute, Haidian District Fuchengmen Road No. 52, Beijing, 100142, China.
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Ohue M, Hamaguchi T, Ito Y, Sakai D, Noura S, Kinugasa Y, Fujita S, Shimada Y, Saito N, Moriya Y. A phase I trial of preoperative S-1 in combination with oxaliplatin and pelvic radiation for lower rectal cancer with T4 and lateral pelvic lymph node metastasis. Int J Clin Oncol 2014; 20:338-44. [PMID: 24839048 DOI: 10.1007/s10147-014-0705-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/27/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this phase I study of the dose escalation of oxaliplatin in combination with oral S-1 and pelvic radiation preoperatively for poor-risk lower rectal cancer was to determine the dose-limiting toxicity (DLT) and recommended dose of oxaliplatin. METHODS Patients with cT4 and lateral pelvic lymph node metastasis, and without distant metastasis (cM0), were treated with weekly oxaliplatin, oral S-1 40 mg/m(2) twice daily for 5 days a week, and radiation. A total of 5 weekly doses of oxaliplatin were planned. RT was administered to a total dose of 50.4 Gy in 28 fractions. RESULTS We enrolled 11 patients between December 2009 and January 2012. DLTs were observed at dose level 1 (50 mg/m(2)) in two patients, one of whom experienced grade 3 aspartate aminotransferase elevation and a grade 3 alanine aminotransferase increase, and the other developed grade 4 hypokalemia and a grade 3 alanine aminotransferase increase. Five patients at dose level 2 (60 mg/m(2)) showed no DLTs. The hematological toxicities in all patients were mild and reversible. One patient showed distant metastasis after chemoradiation. Ten of the 11 patients achieved R0 resection by mesorectal resection and lateral lymph node dissection; three of the 10 underwent combined resection of the other organs. CONCLUSION This phase I trial of preoperative S-1 in combination with oxaliplatin and radiation for lower rectal cancer with T4 and lateral pelvic lymph node metastasis revealed that the recommended dose of oxaliplatin was 60 mg/m(2) weekly.
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Affiliation(s)
- Masayuki Ohue
- Division of Colon and Rectal Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan,
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Lee EM, Hong YS, Kim KP, Lee JL, Kim SY, Park YS, Choi DH, Kim JH, Lim SB, Yu CS, Kim JC, Lee JH, Kim AY, Kim TW. Phase II study of preoperative chemoradiation with S-1 plus oxaliplatin in patients with locally advanced rectal cancer. Cancer Sci 2012; 104:111-5. [PMID: 23057495 DOI: 10.1111/cas.12041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/24/2012] [Accepted: 09/28/2012] [Indexed: 01/23/2023] Open
Abstract
A phase II study of preoperative chemoradiation (CRT) with S-1 plus oxaliplatin in patients with locally advanced rectal cancer was conducted. The total radiotherapy dose was 50.4 Gy. Chemotherapy consisted of oxaliplatin 50 mg/m(2) on days 1, 8, 22 and 29 and S-1 80 mg/m(2) per day on days 1-14 and 22-35. The tumor apparent diffusion coefficient (ADC) was measured using diffusion-weighted magnetic resonance imaging (DW-MRI) before and after CRT. Total mesorectal excision was performed within 6 ± 2 weeks. The primary end-point was the pathological complete response (pCR) rate. A total of 38 patients were enrolled. The pCR rate was 22.9% (8/35; 95% CI, 10.9-42.1), and 10 (28.6%) patients showed near-total tumor regression. There was no grade 4 adverse event, and grade 3 adverse events included leukopenia (5.4%), diarrhea (5.4%), anorexia (2.7%) and nausea (2.7%). The tumor ADC was calculated in 38 patients (including those who participated in the phase I study). The post-CRT ADC (P = 0.037) and the percentage change in ADC (P = 0.026) were significantly correlated with pathological response. In conclusion, preoperative CRT with S-1 plus oxaliplatin showed promising results in pathological responses and favorable toxicity profiles.
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Affiliation(s)
- Eun Mi Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Wada H, Nemoto K, Nomiya T, Murakami M, Suzuki M, Kuroda Y, Ichikawa M, Ota I, Hagiwara Y, Ariga H, Takeda K, Takai K, Fujimoto K, Kenjo M, Ogawa K. A phase I trial of S-1 with concurrent radiotherapy in patients with locally recurrent rectal cancer. Int J Clin Oncol 2012; 18:273-8. [PMID: 22318782 DOI: 10.1007/s10147-012-0375-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 12/29/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this phase I trial of S-1 chemotherapy in combination with pelvic radiotherapy for locally recurrent rectal cancer was to determine the maximum tolerated dose (MTD), recommended dose (RD), and dose-limiting toxicity (DLT) of S-1. METHODS We enrolled 9 patients between April 2005 and March 2009. Radiotherapy (total dose, 60 Gy in 30 fractions) was given to the gross local recurrent tumor and pelvic nodal metastases using three-dimensional radiotherapy planning. We administered oral S-1 twice a day on days 1-14 and 22-35 during radiotherapy. The dose of S-1 was initially 60 mg/m(2)/day and was increased to determine the MTD and RD for this regimen. RESULTS DLT appeared at dose level 2 (70 mg/m(2)/day) in 2 patients, who experienced grade 3 enterocolitis and consequently required suspension of S-1 administration for longer than 2 weeks. Hematological toxicity was mild and reversible. At the initial evaluation, complete regression and partial regression were seen in 1 patient (11%) and 2 patients (22%), respectively. CONCLUSION This phase I trial of S-1 chemotherapy with pelvic radiotherapy for locally recurrent rectal cancer revealed that the MTD for S-1 was 70 mg/m(2)/day and the RD was 60 mg/m(2)/day.
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Affiliation(s)
- Hitoshi Wada
- Department of Radiation Oncology, Miyagi Cancer Center, Nodayama 47-1, Medeshima-shiote, Natori, 981-1293, Japan.
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Hill EJ, Nicolay NH, Middleton MR, Sharma RA. Oxaliplatin as a radiosensitiser for upper and lower gastrointestinal tract malignancies: what have we learned from a decade of translational research? Crit Rev Oncol Hematol 2012; 83:353-87. [PMID: 22309673 DOI: 10.1016/j.critrevonc.2011.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 12/14/2011] [Accepted: 12/28/2011] [Indexed: 01/08/2023] Open
Abstract
Some of the greatest advances in the treatment of solid malignancies have resulted from the combination of chemotherapy and radiotherapy treatments. This article comprehensively reviews the current clinical evidence for oxaliplatin-based chemo-radiotherapy that may improve local control and survival. In order to understand how clinical studies should be designed, the pre-clinical evidence for the use of oxaliplatin chemotherapy as a radiosensitising agent is appraised. Particular focus is placed on oxaliplatin's biological mechanisms of action, including cell cycle effects, the formation of DNA adducts and interstrand cross-links and the role of DNA repair proteins. At a clinical level, there is currently no evidence to suggest that oxaliplatin provides an additional benefit to concurrent chemo-radiation regimes that utilise fluoropyrimidines; we evaluate the reasons for this observation, the limitations of clinical trial design and the opportunities that currently exist to design clinical trials which are underpinned by an understanding of the basic biology.
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Affiliation(s)
- Esme J Hill
- Gray Institute of Radiation Oncology and Biology, Oncology Department, Old Road Campus Research Building, Oxford OX3 7DQ, UK
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