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Mehta A, Vadgaonkar RA, Lewis S, Mahantshetty U, Agarwal JP. Definitive chemo-radiotherapy in cervical oesophageal cancer: a comprehensive review of literature. Rep Pract Oncol Radiother 2024; 29:391-408. [PMID: 39144270 PMCID: PMC11321780 DOI: 10.5603/rpor.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/16/2024] [Indexed: 08/16/2024] Open
Abstract
Background and Objectives Despite decades of experience with definitive chemo-radiotherapy (CRT) in cervical oesophageal cancer (CEC), the loco-regional control and survival outcomes are dismal. This review evaluated the outcomes of various treatment strategies being commonly utilized. Materials and methods A literature review was conducted to identify relevant articles on CEC published from years 2000-2023 addressing the predefined key questions. These questions focussed on the comparative outcomes of various primary treatment approaches (surgery, CRT, or trimodality treatment) and the radiation dose schedules, volumes, and techniques. Results CRT is the standard approach for treatment for CEC so far. The potential role of surgery and trimodality approach in settings of evolving surgical approaches needs to be validated. The high dose schedules that are preferentially practiced in CEC have not shown any benefit in improving the disease outcomes over the standard dose schedule of 50.4 Gy. The target volume delineation practice of elective nodal irradiation (ENI) does not have a proven benefit over the involved field irradiation (IFI). The limited evidence on radiation techniques suggests that intensity-modulated radiotherapy/volumetric-modulated arc therapy (IMRT/VMAT) techniques can improve toxicity profile over three-dimensional conformal radiotherapy (3DCRT), but no advantage proven in disease outcomes so far. Conclusion This review will guide clinicians in decision-making for the management of this relatively rare entity and the directions for future research in these areas. Future large-scale multicentre prospective studies are needed for validating and standardizing our current practices and exploring potential options to improve the outcomes.
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Affiliation(s)
- Ankita Mehta
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Shirley Lewis
- Department of Radiotherapy and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Umesh Mahantshetty
- Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India
| | - JP Agarwal
- Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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2
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van der Zijden CJ, Bouwman A, Mostert B, Nuyttens JJME, van der Sluis PC, Spaander MCW, Mens JWM, Homs MYV, van Doorn L, Wijnhoven BPL, Lagarde SM. Overall survival after definitive chemoradiotherapy for patients with esophageal cancer: a retrospective cohort study. Dis Esophagus 2024:doae047. [PMID: 38836354 DOI: 10.1093/dote/doae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
Definitive chemoradiotherapy (dCRT) is a potentially curative therapy for esophageal cancer. As indications for dCRT differ widely, it is challenging to draw conclusions on outcomes and survival. The aim of this study was to evaluate overall survival (OS) and recurrence patterns according to indications for treatment. Patients who underwent dCRT (50.4 Gy concomitant with carboplatin/paclitaxel) for esophageal cancer between 2012 and 2022 were identified. Indications for dCRT were: cervical tumor, irresectable disease, unfit for surgery, and patient and/or physician preference. The primary endpoint was OS calculated with the Kaplan-Meier method. Secondary endpoints included the proportion of patients that completed the dCRT regimen, 30- and 90-day mortality, and disease recurrence. One hundred and fifty-seven patients were included (72.6% esophageal squamous cell carcinoma) with a median follow-up of 20 months (IQR 10.0-43.9). The full dCRT regimen was completed by 116 patients (73.9%). Thirty- and 90-day mortality were 2.5% and 8.3%, respectively. Median and 5-year OS for all patients were 22.9 months (95% CI 18.0-27.9) and 31.4%, respectively. The median OS per indication was 23.7 months (95% CI 6.5-40.8) for patients with cervical tumors, 10.9 months (95% 0.0-23.2) for irresectable disease, 28.2 months (95% CI 12.3-44.0) for unfit patients, and 22.9 months (95% CI 15.4-30.5) for patients' preference for dCRT (P = 0.11). Disease recurrence was observed in 74 patients (46%), located locoregionally (46%), distant (19%), or combined (35%). Patients who underwent dCRT had a 5-year OS of 31.4%, but OS differed according to indications for treatment with patients who had irresectable disease having the worst prognosis.
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Affiliation(s)
| | - Anna Bouwman
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Bianca Mostert
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost J M E Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan Willem M Mens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marjolein Y V Homs
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Leni van Doorn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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3
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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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4
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Patel DC, Yang CFJ, Liou DZ, Berry MF. Treatment and Outcomes of Proximal Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2023; 30:818-827. [PMID: 36305985 DOI: 10.1245/s10434-022-12683-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/22/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study evaluated the treatment of proximal (cervical or upper thoracic) esophageal squamous cell carcinoma (SCC), for which chemoradiation is the recommended therapy. METHODS Treatment and outcomes of patients with cT1-3N0-1M0 proximal esophageal SCC in the National Cancer Database between 2004 and 2016 was evaluated using logistic regression, Kaplan-Meier analysis, and propensity-score matching. RESULTS Therapy of 2159 patients was chemoradiation (n = 1500, 69.5%), no treatment (n = 205, 9.5%), surgery (n = 203, 9.4%), radiation alone (n = 190, 8.8%), and chemotherapy alone (n = 61, 2.8%). Factors associated with definitive therapy with either chemoradiation or surgery were younger age, non-Black race, being insured, cervical tumor location, clinical T2 and T3 stage, clinical nodal involvement, and treatment at a research/academic program. Five-year survival was significantly better in patients treated with definitive therapy than patients not treated definitively (34.0% vs. 13.3%, p < 0.001). In multivariable survival analysis, receiving definitive therapy (hazard ratio [HR] 0.39, p = 0.017) was associated with improved survival, while increasing age, male sex, clinical T3 stage, positive clinical nodal involvement, and increasing Charlson Comorbidity Index were associated with worse survival. Esophagectomy was not associated with improved survival in multivariable analysis of the definitive therapy cohort (HR 0.84, p = 0.08) or propensity matched analysis. However, the pathologic complete response was only 33.3% (40/120) for patients who did have an esophagectomy after chemoradiation. CONCLUSIONS This national analysis supports definitive chemoradiation for not only cervical but also proximal thoracic esophageal SCC. Routine surgery does not appear to be necessary but may have a role in patients with residual disease after chemoradiation.
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Affiliation(s)
- Deven C Patel
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Douglas Z Liou
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA. .,VA Palo Alto Health Care System, Palo Alto, CA, USA.
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5
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Obermannová R, Alsina M, Cervantes A, Leong T, Lordick F, Nilsson M, van Grieken NCT, Vogel A, Smyth EC. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:992-1004. [PMID: 35914638 DOI: 10.1016/j.annonc.2022.07.003] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- R Obermannová
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Alsina
- Department of Medical Oncology, Hospital Universitario de Navarra (HUN), Pamplona; Gastrointestinal Tumours Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - T Leong
- The Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - F Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases), University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - M Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - N C T van Grieken
- Department of Pathology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - E C Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Schiffner C, Christiansen H, Brandes I, Grannas G, Wichmann J, Merten R. Neoadjuvant versus definitive radiochemotherapy of locoregionally advanced oesophageal cancer-who benefits? Strahlenther Onkol 2022; 198:1062-1071. [PMID: 35416495 DOI: 10.1007/s00066-022-01929-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE For years, there have been discussions on whether neoadjuvant radiochemotherapy followed by surgery (nRCT-S) is superior to definitive radiochemotherapy (dRCT) as the standard of care for locoregionally advanced oesophageal cancer (OC). This retrospective study aimed to evaluate our patient cohort regarding differences in survival and recurrence between nRCT‑S and dRCT. METHODS Data from 68 patients with dRCT and 33 patients with nRCT‑S treated from 2010 to 2018 were analysed. Comorbidities were recorded using the Charlson Comorbidity Index (CCI). Recurrence patterns were recorded as in-field or out-field. Kaplan-Meier analyses were used to compare survival data (overall survival [OS], progression-free survival [PFS], and locoregional control [LRC]). RESULTS Patients with nRCT‑S showed significantly lower CCI values than those with dRCT (p = 0.001). The median follow-up was 47 months. The median OS times were 31 months for nRCT‑S and 12 months for dRCT (p = 0.009), the median PFS times were 11 and 9 months, respectively (p = 0.057), and the median LRC times were not reached and 23 months, respectively (p = 0.037). The only further factor with a significant impact on OS was the CCI (p = 0.016). In subgroup analyses for comorbidities regarding differences in OS, the superiority of the nRCT‑S remained almost significant for CCI values 2-6 (p = 0.061). CONCLUSION Our study showed significantly longer OS and LRC for patients with nRCT‑S than for those with dRCT. Due to different comorbidities in the groups, it can be deduced from the subgroup analysis that patients with few comorbidities seem to especially profit from nRCT‑S.
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Affiliation(s)
- Christoph Schiffner
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Hans Christiansen
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Iris Brandes
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Gerrit Grannas
- Department of Visceral and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jörn Wichmann
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Roland Merten
- Department of Radiation Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Pape M, Vissers PA, de Vos‐Geelen J, Hulshof MC, Gisbertz SS, Jeene PM, van Laarhoven HW, Verhoeven RH. Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population-based study. Cancer Sci 2022; 113:1038-1046. [PMID: 34986523 PMCID: PMC8898723 DOI: 10.1111/cas.15262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/27/2022] Open
Abstract
Data on treatment and survival of patients with advanced unresectable esophageal squamous cell carcinoma (ESCC) from Western populations are limited. Here we describe treatment and survival in patients with advanced unresectable ESCC: patients with cT4b disease without metastases (cT4b), metastases limited to the supraclavicular lymph nodes (SCLNM) or distant metastatic ESCC at the population level. All patients with unresectable (cT4b) or synchronous metastatic ESCC at primary diagnosis (2015-2018) or patients with metachronous metastases after primary non-metastatic diagnosis in 2015-2016 were selected from the Netherlands Cancer Registry. Fifteen percent of patients had cT4b disease (n = 146), 12% SCLNM (n = 118) and 72% distant metastases (n = 681). Median overall survival (OS) time was 6.3, 11.2, and 4.4 months in patients with cT4b, SCLNM, and distant metastases, respectively (P < .001). Multivariable Cox regression showed that patients with cT4b (hazard ratio 1.44, 95% CI 1.04-1.99) and patients with distant metastases (hazard ratio 1.42, 95% CI 1.12-1.80) had a worse survival time compared with patients with SCLNM. Among patients who received chemoradiotherapy and/or underwent resection (primary tumor and/or metastases), median OS was 11.9, 16.1, and 14.0 months in patients with cT4b, SCLNM, and distant metastases, respectively (P = .76). Patients with SCLNM had a better survival time compared with patients with cT4b and patients with distant metastases. Survival of patients with advanced unresectable ESCC in clinical practice was poor, even in patients treated with curative intent.
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Affiliation(s)
- Marieke Pape
- Department of Research & DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Medical OncologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pauline A.J. Vissers
- Department of Research & DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of SurgeryRadboud University Medical CentreNijmegenThe Netherlands
| | - Judith de Vos‐Geelen
- Division of Medical OncologyDepartment of Internal MedicineGROW–School for Oncology and Developmental BiologyMaastricht UMC+MaastrichtThe Netherlands
| | | | - Suzanne S. Gisbertz
- Department of SurgeryAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Paul M. Jeene
- Department of RadiotherapyAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Radiotherapiegroep, location DeventerDeventerThe Netherlands
| | - Hanneke W.M. van Laarhoven
- Department of Medical OncologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Rob H.A. Verhoeven
- Department of Research & DevelopmentNetherlands Comprehensive Cancer Organisation (IKNL)UtrechtThe Netherlands
- Department of Medical OncologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
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8
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Lampis A, Ratti M, Ghidini M, Mirchev MB, Okuducu AF, Valeri N, Hahne JC. Challenges and perspectives for immunotherapy in oesophageal cancer: A look to the future (Review). Int J Mol Med 2021; 47:97. [PMID: 33846775 PMCID: PMC8041478 DOI: 10.3892/ijmm.2021.4930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 12/16/2022] Open
Abstract
Oesophageal cancer is one of the most aggressive malignancies with limited treatment options, thus resulting in a high morbidity and mortality. With 5‑year survival rates of only 5‑10%, oesophageal cancer holds a dismal prognosis for patients. In order to improve overall survival, the early diagnosis and tools for patient stratification for personalized treatment are urgent needs. A minority of oesophageal cancers belong to the spectrum of Lynch syndrome‑associated cancers and are characterized by microsatellite instability (MSI). Microsatellite instability is a consequence of defective mismatch repair protein functions and it has been well characterized in other gastrointestinal tumours, such as colorectal and gastric cancer. In the latter, high levels of MSI are associated with a better prognosis and with an increased benefit to immune‑based therapies. Therefore, similar therapeutic approaches could offer an opportunity of treatment for oesophageal cancer patients with MSI. Apart from immune checkpoint inhibitors, other immunotherapies such as adoptive T‑cell transfer, peptide vaccine and oncolytic viruses are under investigation in oesophageal cancer patients. In the present review, the rationale and current knowledge about immunotherapies in oesophageal cancer are summarised.
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Affiliation(s)
- Andrea Lampis
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
| | - Margherita Ratti
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
- Medical Department, Division of Oncology, Hospital Trust of Cremona, I-26100 Cremona, Italy
| | - Michele Ghidini
- Division of Medical Oncology, Hospital Policlinic 'Fondazione IRCCS Ca' Granda Ospedale Maggiore', I-20122 Milan, Italy
| | - Milko B. Mirchev
- Clinic of Gastroenterology, Medical University, 9002 Varna, Bulgaria
| | | | - Nicola Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton SM25NG, UK
| | - Jens Claus Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
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9
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de Vos-Geelen J, Geurts SME, Nieuwenhuijzen GAP, Voncken FEM, Bogers JA, Braam PM, Muijs CT, de Jong MA, Kasperts N, Rozema T, Blom GJ, Bouwense SAW, Valkenburg-van Iersel LBJ, Jeene PM, Hoebers FJP, Tjan-Heijnen VCG. Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer. Eur J Surg Oncol 2021; 47:2016-2022. [PMID: 33583629 DOI: 10.1016/j.ejso.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/20/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The aim of this retrospective study was to determine the patterns of recurrence and overall survival (OS) in patients achieving clinical complete response after treatment with definitive chemoradiation (CRT) for proximal esophageal cancer. MATERIALS AND METHODS Patients with proximal esophageal cancer treated with CRT between 2004 and 2014 in 11 centers in the Netherlands were included. OS and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Cumulative incidence of first recurrence (locoregional or distant) and locoregional recurrence (LRR) were assessed using competing risk analyses. RESULTS In 197 of the 200 identified patients, response was evaluated, 133 (68%) showed a complete response. In complete responders, median OS, three-year OS, and PFS were 45.0 months (95% CI 34.8-61.5 months), 58% (95% CI 48-66), and 49% (95% CI 40-57), respectively. Three- and five-year risk of recurrence were respectively 40% (95% CI 31-48), and 45% (95% CI 36-54). Three- and five-year risk of LRR were 26% (95% CI 19-33), and 30% (95% CI 22-38). Eight of 32 patients with an isolated LRR underwent salvage surgery, with a median OS of 32.0 months (95% CI 6.8-not reached). CONCLUSION In patients with a complete response after definitive CRT for proximal esophageal cancer, most recurrences were locoregional and developed within the first three years after CRT. These findings suggest to shorten locoregional follow-up from five to three years.
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Affiliation(s)
- J de Vos-Geelen
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands.
| | - S M E Geurts
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
| | - G A P Nieuwenhuijzen
- Dept. of Surgery, Catharina Hospital Eindhoven, P.O. box 1350, 5602, ZA, Eindhoven, the Netherlands
| | - F E M Voncken
- Dept. of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, P.O. box 90203, 1006, BE, Amsterdam, the Netherlands
| | - J A Bogers
- Radiotherapiegroep Arnhem, P.O. box 60160, 6800, JD, Arnhem, the Netherlands
| | - P M Braam
- Dept. of Radiotherapy, RadboudUMC, P.O. box 9101, 6500, HB, Nijmegen, the Netherlands
| | - C T Muijs
- Dept. of Radiation Oncology, University Medical Center Groningen, University of Groningen, P.O. box 11120, 9700, RB, Groningen, the Netherlands
| | - M A de Jong
- Dept. of Clinical Oncology, Leiden University Medical Centre, P.O. box 9699, 2300, RC, Leiden, the Netherlands
| | - N Kasperts
- Dept. of Radiotherapy, University Medical Center Utrecht, P.O. box 85500, 3508, GA, Utrecht, the Netherlands
| | - T Rozema
- Insituut Verbeeten, P.O. box 90120, 5000, LA, Tilburg, the Netherlands
| | - G J Blom
- Dept. of Radiation Oncology, Amsterdam University Medical Centers, VU University, P.O. box 7057, 1007, MB, Amsterdam, the Netherlands
| | - S A W Bouwense
- Dept. of Surgery, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
| | - L B J Valkenburg-van Iersel
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
| | - P M Jeene
- Dept. of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, P.O. box 22660, 1100, DD, Amsterdam, the Netherlands; Radiotherapiegroep Deventer, P.O. box 123, 7400, AC, Deventer, the Netherlands
| | - F J P Hoebers
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. box 3035, 6202, NA, Maastricht, the Netherlands
| | - V C G Tjan-Heijnen
- Dept. of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P.O. box 5800, 6202, AZ, Maastricht, the Netherlands
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Wang J, Ma X, Si H, Ma Z, Ma Y, Wang J, Cao B. Role of long non-coding RNA H19 in therapy resistance of digestive system cancers. Mol Med 2021; 27:1. [PMID: 33402118 PMCID: PMC7786989 DOI: 10.1186/s10020-020-00255-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Digestive system cancers are associated with high morbidity and mortality. Chemotherapy and radiotherapy are the main treatment modalities for these cancers. However, the development of therapy resistance leads to high rates of tumor recurrence and metastasis, resulting in dismal prognosis. Long non-coding RNA (LncRNA) H19, one of the most intriguing non-coding RNAs, has been shown to play a key role in the development and therapy resistance of various digestive system cancers (including hepatocellular carcinoma, colorectal cancer, pancreatic ductal adenocarcinoma, esophageal carcinoma, gastric cancer, and biliary system cancer) by regulating the abnormal expression of genes. In this review, we discuss the potential mechanisms of LncRNA H19 related therapy resistance in the context of digestive system cancers. LncRNA H19 is a potential novel therapeutic target for amelioration of cancer therapy resistance.
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Affiliation(s)
- Jingting Wang
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, #95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Xiao Ma
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, #95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Hai Si
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, #95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Zhongjun Ma
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, #95 Yong An Road, Xicheng District, Beijing, 100050, China
| | - Yan Ma
- Department of Comprehensive Medicine, Beijing Shijingshan Hospital, #24 Shijingshan Road, Shijingshan District, Beijing, 100043, China
| | - Jing Wang
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, #95 Yong An Road, Xicheng District, Beijing, 100050, China. .,Yale School of Medicine, New Haven, CT, USA.
| | - Bangwei Cao
- Department of Oncology, Beijing Friendship Hospital, Capital Medical University, #95 Yong An Road, Xicheng District, Beijing, 100050, China
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