Chemoradiation in conservation therapy for esophageal cancer

Patterns of self-reported symptoms in pancreatic cancer patients receiving chemoradiation

Pancreatic cancer is a lethal disease characterized by multiple disease-related symptoms. Chemoradiation therapy is a standard of treatment for locally advanced pancreatic cancer. Although shown to prolong survival, there is little information about treatment-related symptoms or the palliative benefits of chemoradiation. We assessed symptoms of patients with locally advanced pancreatic cancer receiving chemoradiation to determine the prevalence, and co-occurrence, of symptoms and to identify the extent to which symptoms interfered with function. Forty-eight patients were treated with chemoradiation on a Phase I protocol. Patients received radiotherapy (50.4 Gy in 28 fractions), capecitabine (median dose 825 mg/m(2) twice daily), and bevacizumab (2.5-10 mg/kg). Symptom severity and its interference with function were prospectively assessed (at presentation, during, and after chemoradiation) in 43 consenting patients using the M.D. Anderson Symptom Inventory. Results showed that 95% of patients reported at least one of the 13 symptoms assessed at presentation. The most commonly reported symptoms of moderate to severe (>or=5 on a 0-10 scale) intensity at presentation were lack of appetite (24%), pain (19%), fatigue (19%), and sleep disturbance (10%). We observed an increase in patients reporting moderate to severe fatigue, nausea, and sleep disturbance during chemoradiation. McNemar tests for paired binary observations showed the proportion of patients reporting moderate to severe symptoms significantly (P<0.001) decreased after chemoradiation at 94 days follow-up (lack of appetite=7%, pain=7%, fatigue=13%, sleep disturbance=7%). This study demonstrates the feasibility and usefulness of symptom assessment in chemoradiation protocols. Future studies with larger cohorts are needed to further characterize multiple symptoms associated with chemoradiation.

Unbiased estimation of tumor regression rates during chemoradiotherapy for esophageal carcinoma using CT and stereology

SUMMARY. The purpose of the present study is to estimate tumor volumes of 10 patients with esophageal carcinoma on serial CT images that are obtained before and after chemoradiotherapy using a stereological method. In this study, tumor volume was measured using the Cavalieri method of modern design stereology with a combination of three separate stages. Firstly, detailed systematic series of axial CT images of 1-cm thickness were obtained throughout the whole tumor area of each subject and to magnify them all CT images were projected on a screen by overhead projector and then were marked by manually tracing the outline of areas with tumor on serial CT images that are projected onto the screen. Secondly these images were drawn on paper. Finally the images on paper were evaluated with a point-counting method. It was shown in a pilot study analyzed that 100 test points counted on about 6--8 serial slices through for esophagus wall, lumen and wall + lumen are sufficient to secure coefficient of error (CE) on the estimates of volumes as in this study. It was found that tumor volumes before and after radiotherapy for esophagus wall, lumen and wall + lumen was 10.34 cm(3), 1.15 cm(3) and 11.75 cm(3) before and 5.93 cm(3), 1.43 cm(3) and 7.65 cm(3) after radiotherapy, respectively. When only esophagus wall and lumen volumes or wall + lumen volumes before and after radiotherapy were statistically compared, the difference between either esophagus wall (P<0.01) and lumen (P<0.01) volumes or total volumes (P<.1) were significant. It is concluded that CT estimated tumor volumes may be helpful in both evaluating the clinical situation of patients and providing a simple index to assess the efficiency of therapy, prediction of tumor regression rate and minimizing the risk of chemoradiotherapy damage.