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15.09.2017 | Original Article

Neoadjuvant versus definitive chemoradiotherapy for locally advanced esophageal cancer

Outcomes and patterns of failure

verfasst von: Matthias Felix Haefner, MD, Kristin Lang, Vivek Verma, Stefan Alexander Koerber, Lorenz Uhlmann, Juergen Debus, Florian Sterzing

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2018

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Abstract

Purpose

Randomized trials examining neoadjuvant chemoradiotherapy followed by surgical resection (nCRT-S) and definitive CRT (dCRT) for esophageal cancer (EC) patients are hampered by use of nonstandard treatment paradigms. Outcomes of nCRT-S versus dCRT in a more common patient population are lacking. We investigated local control and survival, evaluated clinical factors associated with endpoints, and assessed patterns of failure between these cohorts.

Methods

We retrospectively analyzed 130 patients with locally advanced EC receiving either dCRT or nCRT-S at our institution from 2000–2012. Inclusion criteria were curatively treated nonmetastatic EC, Karnofsky performance status ≥70%, and receipt of concomitant CRT. Patients were excluded if receiving <41 Gy neoadjuvantly or <50 Gy definitively. Kaplan–Meier analysis was used to evaluate local recurrence (LR), progression-free survival (PFS), and overall survival (OS). Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Patterns of failure were enumerated as local, regional, or distant.

Results

Mean follow-up was 34.2 months. The 3‑year LR was 10.8% in the nCRT-S group and 21.5% in the dCRT group (p = 0.266). Median PFS were 15.6 and 14.9 months, respectively (p = 0.549). Median OS were 20.6 and 25.9 months, respectively (p = 0.81). On univariate and multivariate analysis, none of the investigated factors was associated with outcomes, although node-positive disease showed a trend for worse OS and PFS. Most common failures in both groups were distant (dCRT 31.2% vs. nCRT-S 21.6%) followed by local in-field recurrences (dCRT 26.9% vs. nCRT-S 10.8%).

Conclusions

In this institutional analysis, no significant differences regarding outcomes and patterns of failure were observed between nCRT-S and dCRT.

National Comprehensive Cancer Network (2016) Clinical practice guidelines in oncology—esophageal and esophagogastric junction cancers. https://www.nccn.org/professionals/physician_gls/f_guidelines_nojava.asp. Accessed 20 Sept 2016

van Hagen P, Hulshof MCCM, van Lanschot JJB et al (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(20):2074–2084CrossRefPubMed

Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12(7):681–692CrossRefPubMed

Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23(10):2310–2317CrossRefPubMed

Bedenne L, Michel P, Bouché O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25(10):1160–1168CrossRefPubMed

Kranzfelder M, Schuster T, Geinitz H et al (2011) Meta-analysis of neoadjuvant treatment modalities and definitive non-surgical therapy for oesophageal squamous cell cancer. Br J Surg 98(6):768–783CrossRefPubMed

Lloyd S, Chang BW (2014) Current strategies in chemoradiation for esophageal cancer. J Gastrointest Dig Syst 5(3):156–165

Urba S (2004) Esophageal cancer: preoperative or definitive chemoradiation. Ann Oncol 15(Suppl 4):iv93–iv96PubMed

Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (radiation therapy oncology group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20(5):1167–1174CrossRefPubMed

10.

Chiu PWY, Chan ACW, Leung SF et al (2005) Multicenter prospective randomized trial comparing standard esophagectomy with chemoradiotherapy for treatment of squamous esophageal cancer: early results from the Chinese University research group for esophageal cancer (CURE). J Gastrointest Surg 9(6):794–802CrossRefPubMed

11.

Shiozaki H, Sudo K, Xiao L et al (2014) Distribution and timing of distant metastasis after local therapy in a large cohort of patients with esophageal and esophagogastric junction cancer. Oncology 86(5-6):336–339CrossRefPubMedPubMedCentral

12.

Zhang P, Xi M, Zhao L et al (2015) Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol 116(2):257–261CrossRefPubMed

13.

Robb WB, Messager M, Dahan L et al (2016) Patterns of recurrence in early-stage oesophageal cancer after chemoradiotherapy and surgery compared with surgery alone. Br J Surg 103(1):117–125CrossRefPubMed

14.

Suh Y‑G, Lee IJ, Koom WS et al (2014) High-dose versus standard-dose radiotherapy with concurrent chemotherapy in stages II–III esophageal cancer. Jpn J Clin Oncol 44(6):534–540CrossRefPubMed

15.

Münch S, Aichmeier S, Hapfelmeier A et al (2016) Comparison of dosimetric parameters and toxicity in esophageal cancer patients undergoing 3D conformal radiotherapy or VMAT. Strahlenther Onkol 192(10):722–729CrossRefPubMed

16.

Chuong MD, Hallemeier CL, Jabbour SK et al (2016) Improving outcomes for esophageal cancer using proton beam therapy. Int J Radiat Oncol Biol Phys 95(1):488–497CrossRefPubMed

17.

Zeng YC, Vyas C, Dang Q et al (2016) Proton therapy posterior beam approach with pencil beam scanning for esophageal cancer: Clinical outcome, dosimetry, and feasibility. Strahlenther Onkol 192(12):913–921CrossRefPubMed

18.

Verma V, Lin SH, Simone CB II et al (2016) Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review. J Gastrointest Oncol 7(4):644–664CrossRefPubMedPubMedCentral

19.

Gharzai L, Verma V, Denniston KA et al (2016) Radiation therapy and cardiac death in long-term survivors of esophageal cancer: an analysis of the surveillance, epidemiology, and end result database. PLOS ONE 11(7):e158916CrossRefPubMedPubMedCentral

20.

Wang J, Wei C, Tucker SL et al (2013) Predictors of postoperative complications after trimodality therapy for esophageal cancer. Int J Radiat Oncol Biol Phys 86(5):885–891CrossRefPubMedPubMedCentral

21.

Lin SH, Zhang N, Godby J et al (2016) Radiation modality use and cardiopulmonary mortality risk in elderly patients with esophageal cancer. Cancer 122(6):917–928CrossRefPubMed

22.

Makino T, Doki Y (2011) Treatment of T4 esophageal cancer. Definitive chemo-radiotherapy vs chemo-radiotherapy followed by surgery. Ann Thorac Cardiovasc Surg 17(3):221–228CrossRefPubMed

23.

Vincent J, Mariette C, Pezet D et al (2015) Early surgery for failure after chemoradiation in operable thoracic oesophageal cancer. Analysis of the non-randomised patients in FFCD 9102 phase III trial: Chemoradiation followed by surgery versus chemoradiation alone. Eur J Cancer 51(13):1683–1693CrossRefPubMed

24.

Markar S, Gronnier C, Duhamel A et al (2015) Salvage surgery after chemoradiotherapy in the management of esophageal cancer: is it a viable therapeutic option? J Clin Oncol 33(33):3866–3873CrossRefPubMed

25.

Pennathur A, Luketich JD (2008) Resection for esophageal cancer: strategies for optimal management. Ann Thorac Surg 85(2):S751–S756CrossRefPubMed

26.

Courrech Staal EFW, Aleman BMP, Boot H et al (2010) Systematic review of the benefits and risks of neoadjuvant chemoradiation for oesophageal cancer. Br J Surg 97(10):1482–1496CrossRefPubMed

27.

Beukema JC, van Luijk P, Widder J et al (2015) Is cardiac toxicity a relevant issue in the radiation treatment of esophageal cancer? Radiother Oncol 114(1):85–90CrossRefPubMed

28.

Schröder C, Engenhart-Cabillic R, Vorwerk H et al (2017) Changes in pulmonary function and influencing factors after high-dose intrathoracic radio(chemo)therapy. Strahlenther Onkol 193(2):125–131CrossRefPubMed

29.

Rees J, Hurt CN, Gollins S et al (2015) Patient-reported outcomes during and after definitive chemoradiotherapy for oesophageal cancer. Br J Cancer 113(4):603–610CrossRefPubMedPubMedCentral

30.

Mariette C, Dahan L, Mornex F et al (2014) Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol 32(23):2416–2422CrossRefPubMed

31.

Lin SH, Wang J, Allen PK et al (2014) A nomogram that predicts pathologic complete response to neoadjuvant chemoradiation also predicts survival outcomes after definitive chemoradiation for esophageal cancer. J Gastrointest Oncol 6(1):45–52. https://doi.org/10.3978/j.issn.2078-6891.2014.054

Titel: Neoadjuvant versus definitive chemoradiotherapy for locally advanced esophageal cancer
Outcomes and patterns of failure
verfasst von: Matthias Felix Haefner, MD
Kristin Lang
Vivek Verma
Stefan Alexander Koerber
Lorenz Uhlmann
Juergen Debus
Florian Sterzing
Publikationsdatum: 15.09.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1211-0

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Neoadjuvant versus definitive chemoradiotherapy for locally advanced esophageal cancer

Outcomes and patterns of failure