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Hirata K, Yoshida K, Katada C, Watanabe A, Tsushima T, Yamaguchi T, Yamamoto S, Ishikawa H, Sato Y, Imamura CK, Tanigawara Y, Ito Y, Kato K, Kitagawa Y, Hamamoto Y. Definitive chemoradiotherapy with paclitaxel for locally advanced esophageal squamous cell carcinoma in older patients (PARADISE-1): a phase I trial. BMC Cancer 2024; 24:873. [PMID: 39030570 PMCID: PMC11264717 DOI: 10.1186/s12885-024-12653-4] [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: 04/21/2023] [Accepted: 07/17/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND In older patients, esophageal squamous cell carcinoma (ESCC) is difficult to treat using standard therapies, including surgery and cisplatin-based chemoradiotherapy. Paclitaxel (PTX) has radiosensitizing activity. We conducted a phase I trial of PTX combined with radiotherapy to establish a standard therapy for locally advanced ESCC in older patients. METHODS Enrollment was conducted at six centers in Japan from April 2016 to September 2019. The participants were aged ≥ 70 years, had locally advanced ESCC, and were intolerant to surgery or unwilling. A fixed 60-Gy radiation dose was administered in 30 fractions. PTX dosing levels started at 30 mg/m2 weekly for 6 weeks. Depending on the number of DLTs, the dose was set to be increased by 10 mg/m2 or switched to biweekly. A geriatric assessment was performed before treatment using the Geriatric-8 screening tool. The primary endpoint was dose-limiting toxicity (DLT). RESULTS We enrolled 24 patients (6 per group); DLT was observed in one (grade 4 hypokalemia), one (grade 3 aspiration), two (grade 3 radiodermatitis, grade 3 esophageal hemorrhage), and two (grade 3 anorexia, grade 5 pneumonitis) patients in the weekly PTX 30, 40, 50, and 60 mg/m2 groups, respectively. All adverse events, except death in the 60 mg/m2 group, showed reversible improvement, and the safety profile was considered acceptable. The 2-year survival and complete response rates were 40.0% and 54.2%, respectively. There was a significant difference in survival between favorable and unfavorable Geriatric-8 scores. CONCLUSIONS The recommended PTX dose with concomitant radiation was determined to be 50 mg/m2 weekly. Phase II trials at this dose are underway.
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Affiliation(s)
- Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kayo Yoshida
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akinori Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 , Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Toshifumi Yamaguchi
- Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-Cho, Takatsuki, Osaka, 569-8686, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 1-3-3Higashinari-Ku, NakamichiOsaka, 537-8511, Japan
| | - Hideki Ishikawa
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 3-2-17-2F Imabashi, Chuo-Ku, Osaka, 541-0042, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Chiyo K Imamura
- Advanced Cancer Translational Research Institute, Showa University, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yusuke Tanigawara
- Laboratory of Pharmacometrics and Systems Pharmacology, Keio Frontier Research & Education Collaborative Square at Tonomachi, Keio University, 3-25-10 Tonomachi, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0821, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
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Jingu K, Numasaki H, Toh Y, Nemoto K, Uno T, Doki Y, Matsubara H. Chemoradiotherapy and radiotherapy alone in patients with esophageal cancer aged 80 years or older based on the Comprehensive Registry of Esophageal Cancer in Japan. Esophagus 2020; 17:223-229. [PMID: 32088786 DOI: 10.1007/s10388-020-00725-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND There has been no definitive evidence of chemoradiotherapy being superior to radiotherapy alone in patients aged 80 years or older. The purpose of the present study was to evaluate the results of radiotherapy and chemoradiotherapy in patients aged 80 years or older with esophageal cancer in the Japanese Nationwide Cancer Database. METHODS A total of 358 patients aged 80 years or older who were treated with radiotherapy alone or with chemoradiotherapy for esophageal cancer between 2009 and 2011 were enrolled. RESULTS The 5-year overall survival (OS) rates in patients with cStages 0-I, II, III and IV were 40.9%, 24.7%, 12.2% and 4.9%, respectively. The 5-year cause-specific survival (CSS) rates in patients aged 80 years or older with cStages 0-I, cStage II, cStage III and cStage IV were 73.5%, 41.4%, 25.3% and 7.4%, respectively. In patients treated with radiotherapy alone, the 5-year OS rates for patients with cStages 0-I, II, III and IV were 36.5%, 12.0%, 5.4% and 0%, respectively. In patients treated with chemoradiotherapy, the 5-year OS rates for patients with cStages 0-I, II, III and IV were 45.0%, 36.1%, 16.4% and 7.1%, respectively. In multivariate analysis, chemoradiotherapy, early stage and squamous cell carcinoma were significantly favorable prognostic factors for OS in patients aged 80 years or older (p < 0.001, p < 0.001 and p = 0.0323, respectively). We were unable to evaluate toxicities, because of lack of information in the registry. CONCLUSION Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older is a significantly favorable prognostic factor for OS. However, chemoradiotherapy should be carefully selected in elderly patients.
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Affiliation(s)
- Keiichi Jingu
- Japan Esophageal Society, Tokyo, Japan. .,Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
| | - Hodaka Numasaki
- Japan Esophageal Society, Tokyo, Japan.,Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Toh
- Japan Esophageal Society, Tokyo, Japan.,Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kenji Nemoto
- Japan Esophageal Society, Tokyo, Japan.,Department of Radiology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takashi Uno
- Japan Esophageal Society, Tokyo, Japan.,Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yuichiro Doki
- Japan Esophageal Society, Tokyo, Japan.,Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hisahiro Matsubara
- Japan Esophageal Society, Tokyo, Japan.,Department of Frontier Surgery, Chiba University, Chiba, Japan
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3
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Chen M, Liu X, Han C, Wang X, Zhao Y, Pang Q, Sun X, Li G, Zhang K, Li L, Qiao X, Lin Y, Chen J, Xiao Z. Does chemoradiotherapy benefit elderly patients with esophageal squamous cell cancer? A propensity-score matched analysis on multicenter data (3JECROG R-03A). BMC Cancer 2020; 20:36. [PMID: 31941487 PMCID: PMC6964023 DOI: 10.1186/s12885-019-6461-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the present study was to assess the efficacy of concurrent chemoradiotherapy (CRT) or radiotherapy alone (RT-alone) in elderly patients with esophageal squamous cell carcinoma (ESCC). Methods The clinical data of patients with ESCC treated with RT-alone or CRT were collected and retrospectively reviewed. The 1-, 3- and 5-year overall survival (OS) rates and the clinical characteristics correlated with survival were analyzed statistically. Propensity score matching (PSM) analyses were used to compensate for differences in baseline characteristics between the CRT and RT-alone groups to confirm the survival difference. Results A total of 729 patients fulfilling the inclusion criteria were reviewed. Diabetes, primary tumor volume (pTV), primary tumor location (pTLo), clinical T stage,(cT) clinical N stage (cN), clinical M stage (cM) and short-term response to RT were independent factors influencing OS (P = 0.002–0.044). The 5-year OS rate was 26.6, 26.0 and 30.1% in the whole cohort, RT-alone and CRT groups, respectively. The survival difference between RT alone and CRT was not significant before or following PSM. Compared with the corresponding subgroups treated with RT alone, CRT significantly benefited patients with diabetes (P = 0.003), cT4 (P = 0.030) and cN0 (P = 0.049), whereas no benefit was identified between CRT and RT alone in the other subgroups, including cT1–3, cN1, cM, pTLo, pTV, age and gender. Conclusions CRT with the current chemotherapy regimens may not improve the survival of elderly ESCC patients compared to RT-alone, except in patients with cT4 stage, cN0 stage or diabetes. However, due to the limitation of the retrospective nature of the current study, further clinical trials are required for confirmation.
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Affiliation(s)
- Mingqiu Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, No. 420, Fumalu Road, Jinan District, Fuzhou City, Fujian Province, People's Republic of China
| | - Xiaohong Liu
- The Graduate School, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Chun Han
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yidian Zhao
- Department 4th of Radiation Oncology, Anyang Cancer Hospital, Anyang, 455000, China
| | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital/National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Xinchen Sun
- Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Gaofeng Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, 277599, China
| | - Ling Li
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, 277599, China
| | - Xueying Qiao
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
| | - Yu Lin
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, No. 420, Fumalu Road, Jinan District, Fuzhou City, Fujian Province, People's Republic of China
| | - Junqiang Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, No. 420, Fumalu Road, Jinan District, Fuzhou City, Fujian Province, People's Republic of China.
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Frelaut M, De Glas N, Zapardiel I, Kaidar-Person O, Kfoury M, You B, Banerjee S, Brain E, Falandry C, Rodrigues M. Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey. Cancers (Basel) 2019; 11:E1955. [PMID: 31817566 PMCID: PMC6966543 DOI: 10.3390/cancers11121955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 01/22/2023] Open
Abstract
Although a quarter of cervical cancers occur after the age of 65 years, there is no treatment consensus for these patients. The aim of this work was to survey how physicians treat patients with advanced cervical cancer, focusing on treatment adjustments according to age and frailty status. Specialists were invited to an online survey. Data collected included information on respondent and treatment strategy in four cases (FIGO IIb, FIGO IVa, FIGO IVb, metastatic recurrence) with three age scenarios (45-year-old, 75-year-old and fit, 75-year-old and unfit). We received 237 responses of which 117 were fully completed. Thirty-four percent of respondents reported they had available access to a geriatric team and 25% used a frailty screening tool in routine. Therapeutic strategies did not differ between young and old fit patients. However, treatment modalities and intensity were different for old and unfit patients. Physicians answered that they would treat old fit patients as their younger counterparts but would reduce treatment intensity for old unfit patients. However, even if they were willing to adapt their treatment strategy based on frailty status, most of them do not use the tools that would allow distinguishing "fit" and "unfit" older patients, leaving room for improving accurate geriatric evaluation.
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Affiliation(s)
- Maxime Frelaut
- Department of Medical Oncology, Institut Curie, Paris Science & Lettres Research University, 75005 Paris, France; (M.F.); (E.B.)
| | - Nienke De Glas
- Internal Medicine, Leiden University Medical Center, 2316 Leiden, The Netherlands;
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital-IdiPAZ, 28046 Madrid, Spain;
| | - Orit Kaidar-Person
- Division of Oncology, Radiotherapy Unit, Rambam Health Care Campus, 31096 Haifa, Israel;
| | - Maria Kfoury
- Association d’Enseignement de Recherche des Internes en Oncologie, 75005 Paris, France;
| | - Benoit You
- Department of Medical Oncology, Lyon Sud Hospital Center, Centre d’Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Institute of Cancerology, Hospices Civils de Lyon (IC-HCL), 69002 Lyon, France;
- Unité Ciblage Thérapeutique en Oncologie Université Claude Bernard Lyon 1, Hospices Civils de Lyon 3738, Faculty of Medicine-Lyon Sud, University of Lyon 1, 69600 Oullins, France
| | - Susana Banerjee
- Gynae Oncology Unit, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK;
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Paris Science & Lettres Research University, 75005 Paris, France; (M.F.); (E.B.)
| | - Claire Falandry
- Geriatric Unit, Centre Hospitalier Lyon Sud, 69 495 Pierre-Bénite, France;
- CarMen biomedical research laboratory (Cardiovascular diseases, Metabolism, diabetology and Nutrition) Institut national de la santé et de la recherche médicale (INSERM) U1060, Université de Lyon, 69600 Oullins, France
| | - Manuel Rodrigues
- Department of Medical Oncology, Institut Curie, Paris Science & Lettres Research University, 75005 Paris, France; (M.F.); (E.B.)
- Institut Curie, Institut national de la santé et de la recherche médicale (INSERM), PSL Research University, U830, 75005 Paris, France
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Matsumoto Y, Kimura K, Zhou Q, Sasaki K, Saiki T, Moriyama M, Saijo Y. Treatments and outcomes of older patients with esophageal cancer: Comparison with younger patients. Mol Clin Oncol 2019; 11:383-389. [PMID: 31475066 PMCID: PMC6713945 DOI: 10.3892/mco.2019.1909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/24/2019] [Indexed: 12/28/2022] Open
Abstract
The number of older patients with esophageal cancer (EC) is increasing due to the population aging and increasing life expectancy. However, no optimal treatment strategy for older patients with EC has been established to date. The aim of the present study was to review and compare the treatment modalities and outcomes of 990 younger and older patients diagnosed with EC in our institution. The patients were divided into younger (≤74 years) and older (≥75 years) groups. The majority of the patients in both groups had early-stage EC and were treated by endoscopic submucosal dissection (ESD). The older patients with locally advanced (stage II and III) EC were more likely to undergo chemoradiotherapy rather than esophagectomy. Among the older patients, 22% selected best supportive care. The disease-specific survival rate of the older patients was significantly lower compared with that of the younger patients, which was likely due to the less intense treatment modalities applied. The prognosis following esophagectomy was significantly better compared with that of chemoradiotherapy in the younger, but not in the older patients. In conclusion, the poorer prognosis of older patients (aged ≥75 years) with stage I EC may improve with multidisciplinary treatment after ESD. Although CRT is currently considered the optimal treatment for older patients with stage II/III EC, more efficient treatment modalities are urgently required.
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Affiliation(s)
- Yoshifumi Matsumoto
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | | | - Qiliang Zhou
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kenta Sasaki
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Takuro Saiki
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Masato Moriyama
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yasuo Saijo
- Department of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Hamamoto Y, Sakakibara N, Nagashima F, Kitagawa Y, Higashi T. Treatment selection for esophageal cancer: evaluation from a nationwide database. Esophagus 2018; 15:109-114. [PMID: 29892936 DOI: 10.1007/s10388-018-0605-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/28/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Most elderly patients poorly tolerate the standard treatment for esophageal cancer; however, little information is available regarding the appropriateness of non-standard esophageal cancer treatments for those patients. This study aims to analyze the treatment costs and completion rates of patients undergoing a real-world treatment for esophageal cancer to elucidate the treatment selection and its quality. MATERIALS AND METHODS We analyzed treatment costs and completion rates for patients with esophageal cancer and analyzed these data relative to patient age and center volumes. Patients with esophageal cancer [UICC, TMN, Clinical stage II/III (excluding T4)] who were diagnosed in 2013 were analyzed. Patients were classified into five groups defined as follows: surgical therapy, chemotherapy, concurrent chemoradiotherapy (CCRT), modified concurrent chemoradiotherapy (mCRT), and radiotherapy (RT). RESULTS Mean and median age of patients who received surgery and CCRT were comparable; however, patients who underwent mCRT and RT tended to be older. Medical costs associated with surgery were higher than costs associated with other non-surgical treatments. Cost and completion rate of chemoradiotherapy did not differ between CCRT and mCRT; however, both had higher completion rates compared to that of RT. Surgical expenses tended to be the highest in low-volume centers and the lowest in high-volume centers. CONCLUSION Treatment of esophageal cancer at high-volume centers seems well balanced compared with medium- to low-volume centers. mCRT was widely performed and comparable in medical cost to CCRT, although additional clinical impacts were unclear.
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Affiliation(s)
- Yasuo Hamamoto
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan. .,Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.
| | - Naoki Sakakibara
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan
| | - Fumio Nagashima
- Department of Medical Oncology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan
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Tsukada Y, Higashi T, Shimada H, Kikuchi Y, Terahara A. The use of neoadjuvant therapy for resectable locally advanced thoracic esophageal squamous cell carcinoma in an analysis of 5016 patients from 305 designated cancer care hospitals in Japan. Int J Clin Oncol 2017; 23:81-91. [PMID: 28795280 DOI: 10.1007/s10147-017-1178-y] [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] [Received: 05/17/2017] [Accepted: 07/31/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies have shown the benefits of neoadjuvant therapy with chemotherapy or chemoradiotherapy for resectable locally advanced thoracic esophageal squamous cell carcinoma (ESCC). The aim of our study was to elucidate the use of neoadjuvant therapy for thoracic ESCC in Japan. METHODS Data on patients with stage IB-III thoracic ESCC were retrieved from the national database of hospital-based cancer registries combined with claims data between 2012 and 2013. These data were analyzed using a mixed-effect logistic regression analysis, with a focus on exploring patterns in the first-line treatment for ESCC, including proportion of patients who received neoadjuvant therapy, and investigating the hospital characteristics and patient factors associated with the use of neoadjuvant therapy. RESULTS Of the 5016 patients with stage IB-III thoracic ESCC at the 305 participating hospitals, 34.2% received neoadjuvant therapy (neoadjuvant chemotherapy, 29.5%; neoadjuvant chemoradiotherapy, 4.7%). The therapy was less likely to be administered to older patients (≤64 years, 48.8%; 65-70 years, 42.0%; 70-75 years, 33.9%; 75-80 years, 22.2%; 80-85 years, 3.8%; ≥85 years, 1.4%) and at hospitals with a low volume of patients (very high, 42.1%; high, 37.5%; low, 30.7%; and very low, 26.4%). This trend was confirmed by regression analysis. CONCLUSIONS Based on our results, in Japan, relatively few patients with resectable locally advanced thoracic ESCC receive neoadjuvant therapy, with older patients and patients at lower volume hospitals being less likely than other patients to receive the neoadjuvant therapy. We recommend that the process of treatment decision-making be assessed at both the patient and hospital levels so that patients can consider various treatment options, including neoadjuvant therapy with surgery in Japan.
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Affiliation(s)
- Yoichiro Tsukada
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan. .,Department of Clinical Oncology, Toho University Graduate School of Medicine, Tokyo, Japan.
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hideaki Shimada
- Department of Surgery, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Yoshinori Kikuchi
- Division of Gastorenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Atsuro Terahara
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
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