Nonsurgical management of esophageal adenocarcinoma.

Journal article

BACKGROUND: The benefit of induction chemotherapy (IC) before chemoradiotherapy (CRT) for inoperable esophageal adenocarcinoma has not been established. To clarify toxicities and outcomes of combined modality treatment, we performed a retrospective review. MATERIALS AND METHODS: Sixty-eight consecutive patients were identified. Fifty-one patients had CRT, 17 had radiotherapy (RT). Fifty-eight received IC before RT. IC consisted of 4 cycles of platinum and fluoropyrimidines followed by CRT 54 Gy with concurrent infusional 5-fluorouracil (5-FU) or capecitabine. Response to IC was assessed at 3 months and response to CRT at 3 months. Time to progression (TTP) and overall survival (OS) are reported. RESULTS: Fifty-four patients were men and 14 were women, with median age 72 years (range, 42-87 years). There were 29 stage II, 33 stage III, 4 stage IVa, and 2 stage IVb tumors. The response 3 months after completion of treatment was 39.6%. No grade 4 toxicity was reported, but 10/58 patients had grade 3 toxicity from IC. The median TTP and OS from RT for the entire cohort was 12 months (95% confidence interval [CI], 7-18) and 16 months (95% CI, 5-27), respectively. The 1- and 2-year survival rates from diagnosis were 73% and 47%, respectively. There was no statistically significant difference in TTP or OS in patients who responded to IC compared with those who did not (median TTP 11 vs. 12 months, respectively; P = .8; median OS 15 vs. 14 months, respectively; P = .8). CONCLUSION: The outcome in patients with adenocarcinoma of the esophagus after CRT is comparable to unselected surgical series. Response to IC is not always an indicator of eventual outcome.

Authors: Gujral, D; Hawkins, M; Leonulli, BG; Ashley, S; Chau, I

• Publication status: Published
• Journal: Clinical colorectal cancer
• Volume: 10
• Issue: 3
• Pages: 165-170
• Publication date: 2011-09-01
• DOI: 10.1016/j.clcc.2011.03.017
• EISSN: 1938-0674
• ISSN: 1533-0028
• Language: English
• Keywords: Aged; Male; Induction Chemotherapy; Treatment Outcome; Antineoplastic Combined Chemotherapy Protocols; Adult; Carcinoma, Squamous Cell; Chemoradiotherapy; Retrospective Studies; Follow-Up Studies; Aged, 80 and over; Neoplasm Staging; Cisplatin; Adenocarcinoma; Esophageal Neoplasms; Deoxycytidine; Fluorouracil; Cohort Studies; Humans; Epirubicin; Middle Aged; Lymphatic Metastasis; Female; Survival Rate