nach oben

06.01.2025 | Ösophaguskarzinom | Leitthema

Definitive Radiochemotherapie des Ösophaguskarzinoms: etablierte Therapie und neue Standards

verfasst von: N. Guberina, M. Guberina, Y. Alberti, M. Stuschke

Einloggen, um Zugang zu erhalten

Zusammenfassung

Dank der Entwicklung moderner Techniken, intensitätsmodulierter Radiotherapie (IMRT), volumenintensitätsmodulierter Rotationsbestrahlung (VMAT), bildgeführter und adaptiver Radiotherapie (IGRT und ART) ist die moderne Strahlentherapie des Ösophaguskarzinoms bei größerer Präzision und optimierter Konformität zu einer gut tolerablen, auch im hohen Lebensalter einsetzbaren Behandlungsmodalität geworden. Normalgewebe, insbesondere Herz und Lunge werden bei der Therapieplanung sorgfältig berücksichtigt. In Kombination mit einer Chemotherapie ist die Strahlentherapie eine potenziell kurative Behandlungsmöglichkeit für funktionell nichtoperable Patienten und für chirurgisch oder endoskopisch nichtresektable Ösophaguskarzinome. Die Indikation zur Radiochemotherapie soll von einem erfahrenen interdisziplinären Team unter Abwägung aller therapeutischen Alternativen gestellt werden. Die Häufigkeit klinisch kompletter Remissionen liegt nach definitiver Radiochemotherapie zwischen 30 und 55 %. Posttherapeutische supportive Maßnahmen können von entscheidender Bedeutung für die Lebensqualität sein. Weitere Effektivitätssteigerungen der Radiochemotherapie bei einer Dosis von 50,4 Gy in konventioneller Fraktionierung werden durch eine sequenzielle oder simultane Immuntherapie mit Immuncheckpointinhibitoren und die weitere Optimierung der Chemotherapiekomponente erwartet.

Nur mit Berechtigung zugänglich

Al-Batran SE, Homann N, Pauligk C et al (2019) Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet 393:1948–1957. https://doi.org/10.1016/S0140-6736(18)32557-1CrossRefPubMed

Bostel T, Nikolaidou E, Wollschläger D et al (2024) Multicenter analysis on the value of standard (chemo)radiotherapy in elderly patients with locally advanced adenocarcinoma of the esophagus or gastroesophageal junction. Radiat Oncol 19:28. https://doi.org/10.1186/s13014-024-02414-9CrossRefPubMedPubMedCentral

Boekhoff MR, Lagendijk JJW, van Lier ALHMW, Mook S, Meijer GJ (2023) Intrafraction motion analysis in online adaptive radiotherapy for esophageal cancer. Phys Imaging Radiat Oncol 26:100432. https://doi.org/10.1016/j.phro.2023.100432CrossRefPubMedPubMedCentral

Boustani J, Rivin Del Campo E, Blanc J et al (2019) Quality assurance of dose-escalated radiation therapy in a randomized trial for locally advanced oesophageal cancer. Int J Radiat Oncol Biol Phys 105:329–337. https://doi.org/10.1016/j.ijrobp.2019.06.2542CrossRefPubMed

Bridges S, Thomas B, Radhakrishna G et al (2022) SCOPE 2—still answering the unanswered questions in oesophageal radiotherapy? SCOPE 2: a randomised phase II/III trial to study radiotherapy dose escalation in patients with oesophageal cancer treated with definitive chemoradiation with an embedded phase II trial for patients with a poor early response using positron emission tomography/computed tomography. Clin Oncol 34:e269–e280. https://doi.org/10.1016/j.clon.2022.03.019CrossRef

Brower JV, Chen S, Bassetti MF et al (2016) Radiation dose escalation in esophageal cancer revisited: a contemporary analysis of the national cancer data base, 2004 to 2012. Int J Radiat Oncol Biol Phys 96:985–993. https://doi.org/10.1016/j.ijrobp.2016.08.016CrossRefPubMed

Buckstein M, Liu J (2019) Cervical esophageal cancers: challenges and opportunities. Curr Oncol Rep 21:46. https://doi.org/10.1007/s11912-019-0801-7CrossRefPubMed

Burmeister BH, Dickie G, Smithers BM, Hodge R, Morton K (2000) Thirty-four patients with carcinoma of the cervical esophagus treated with chemoradiation therapy. Arch Otolaryngol Head Neck Surg 126:205–208. https://doi.org/10.1001/archotol.126.2.205CrossRefPubMed

Chen CC, Yeh HL, Chuang CY, Hsu CP (2024) A phase II study of neoadjuvant chemoradiotherapy with docetaxel, cisplatin and 5‑FU followed by surgical resection in the treatment of locally advanced Esophagogastric junction cancer and locally advanced esophageal cancer. Clin Pract 14:642–652. https://doi.org/10.3390/clinpract14020051CrossRefPubMedPubMedCentral

10.

Conroy T, Galais MP, Raoul JL et al (2014) Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol 15:305–314. https://doi.org/10.1016/S1470-2045(14)70028-2CrossRefPubMed

11.

Cooper L, Dezube AR, De León LE et al (2021) Outcomes of trimodality CROSS regimen in older adults with locally advanced esophageal cancer. Eur J Surg Oncol 47:2667–2674. https://doi.org/10.1016/j.ejso.2021.04.013CrossRefPubMedPubMedCentral

12.

Crehange G, M’vondo C, Bertaut A et al (2021) Exclusive chemoradiotherapy with or without radiation dose escalation in esophageal cancer: multicenter phase 2/3 randomized trial CONCORDE (Prodige-26). Int J Radiat Oncol Biol Phys 111:3CrossRef

13.

Crosby T, Hurt CN, Falk S et al (2013) Chemoradiotherapy with or without cetuximab in patients with oesophageal cancer (SCOPE1): a multicentre, phase 2/3 randomised trial. Lancet Oncol 14:627–637. https://doi.org/10.1016/S1470-2045(13)70136-0CrossRefPubMed

14.

De B, Rhome R, Doucette J, Buckstein M (2017) Dose escalation of definitive radiation is not associated with improved survival for cervical esophageal cancer: a national cancer data base (NCDB) analysis. Dis Esophagus 30:1–10. https://doi.org/10.1093/dote/dow037CrossRefPubMed

15.

De Virgilio A, Costantino A, Festa BM et al (2023) Oncological outcomes of squamous cell carcinoma of the cervical esophagus treated with definitive (chemo-)radiotherapy: a systematic review and meta-analysis. J Cancer Res Clin Oncol 149:1029–1041. https://doi.org/10.1007/s00432-022-03965-8CrossRefPubMed

16.

de Vos-Geelen J, Geurts SME, Nieuwenhuijzen GAP et al (2021) Patterns of recurrence following definitive chemoradiation for patients with proximal esophageal cancer. Eur J Surg Oncol 47:2016–2022. https://doi.org/10.1016/j.ejso.2021.02.001CrossRefPubMed

17.

Guberina M, Santiago Garcia A, Khouya A et al (2023) Comparison of online-onboard adaptive intensity-modulated radiation therapy or volumetric-modulated arc radiotherapy with image-guided radiotherapy for patients with gynecologic tumors in dependence on Fractionation and the planning target volume margin. JAMA Netw Open 6:e234066CrossRefPubMedPubMedCentral

18.

Guberina M, Santiago A, Pöttgen C et al (2023) Respiration-controlled radiotherapy in lung cancer: Systematic evaluation of the optimal application practice. Clin Transl Radiat Oncol 40:100628. https://doi.org/10.1016/j.ctro.2023.100628CrossRefPubMedPubMedCentral

19.

Guberina M, Guberina N, Hoffmann C et al (2024) Prospects for online adaptive radiation therapy (ART) for head and neck cancer. Radiat Oncol 19:4. https://doi.org/10.1186/s13014-023-02390-6CrossRefPubMedPubMedCentral

20.

Guberina N, Pöttgen C, Santiago A et al (2023) Machine-learning-based prediction of the effectiveness of the delivered dose by exhale-gated radiotherapy for locally advanced lung cancer: the additional value of geometric over dosimetric parameters alone. Front Oncol 12:870432. https://doi.org/10.3389/fonc.2022.870432CrossRefPubMedPubMedCentral

21.

Gui Z, Hu W, Kong Q, Liu C, Xu Y, Wang F (2022) Esophageal stenosis as an independent factor of poor prognosis in patients with ESCC treated with definitive chemoradiotherapy. Future Oncol 18:4193–4207. https://doi.org/10.2217/fon-2022-0125CrossRefPubMed

22.

Gwynne S, Higgins E, Poon King A et al (2019) Driving developments in UK oesophageal radiotherapy through the SCOPE trials. Radiat Oncol 14:26. https://doi.org/10.1186/s13014-019-1225-0CrossRefPubMedPubMedCentral

23.

Herskovic A, Martz K, al-Sarraf M et al (1992) Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 326:1593–1598CrossRefPubMed

24.

Hoeben A, Polak J, Van De Voorde L, Hoebers F, Grabsch HI, de Vos-Geelen J (2016) Cervical esophageal cancer: a gap in cancer knowledge. Ann Oncol 27:1664–1674. https://doi.org/10.1093/annonc/mdw183CrossRefPubMed

25.

Hoeppner J, Lordick F, Brunner T et al (2016) ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer 16:503. https://doi.org/10.1186/s12885-016-2564-yCrossRefPubMedPubMedCentral

26.

Honing J, Smit JK, Muijs CT et al (2014) A comparison of carboplatin and paclitaxel with cisplatinum and 5‑fluorouracil in definitive chemoradiation in esophageal cancer patients. Ann Oncol 25:638–643. https://doi.org/10.1093/annonc/mdt589CrossRefPubMedPubMedCentral

27.

Hulshof MCCM, Geijsen ED, Rozema T et al (2021) Randomized study on dose escalation in definitive chemoradiation for patients with locally advanced esophageal cancer (ARTDECO study). J Clin Oncol 39:2816–2824. https://doi.org/10.1200/JCO.20.03697CrossRefPubMed

28.

Jia R, Shan T, Zheng A et al (2024) Capecitabine or capecitabine plus oxaliplatin versus fluorouracil plus cisplatin in definitive concurrent chemoradiotherapy for locally advanced esophageal squamous cell carcinoma (CRTCOESC): a multicenter, randomized, open-label, phase 3 trial. J Clin Oncol 42:2436–2445. https://doi.org/10.1200/JCO.23.02009CrossRefPubMed

29.

Kato K, Machida R, Ito Y et al (2024) Doublet chemotherapy, triplet chemotherapy, or doublet chemotherapy combined with radiotherapy as neoadjuvant treatment for locally advanced oesophageal cancer (JCOG1109 NExT): a randomised, controlled, open-label, phase 3 trial. Lancet 404:55–66. https://doi.org/10.1016/S0140-6736(24)00745-1CrossRefPubMed

30.

Kelly RJ, Ajani JA, Kuzdzal J et al (2021) Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med 384:1191–1203. https://doi.org/10.1056/NEJMoa2032125CrossRefPubMed

31.

Kroese TE, Bronzwaer S, van Rossum PSN et al (2024) European clinical practice guidelines for the definition, diagnosis, and treatment of oligometastatic esophagogastric cancer (OMEC-4). Eur J Cancer 204:114062. https://doi.org/10.1016/j.ejca.2024.114062CrossRefPubMed

32.

Liu Q, Zhu Z, Chen Y et al (2020) Phase 2 study of stereotactic body radiation therapy for patients with oligometastatic esophageal squamous cell carcinoma. Int J Radiat Oncol Biol Phys 108(3):707–715. https://doi.org/10.1016/j.ijrobp.2020.05.003CrossRefPubMed

33.

Liu S, Hossinger A, Heumüller SE et al (2021) Highly efficient intercellular spreading of protein misfolding mediated by viral ligand-receptor interactions. Nat Commun 12:5739. https://doi.org/10.1038/s41467-021-25855-2CrossRefPubMedPubMedCentral

34.

Liu X, Zhang Y, Yang KY et al (2024) Induction-concurrent chemoradiotherapy with or without sintilimab in patients with locoregionally advanced nasopharyngeal carcinoma in China (CONTINUUM): a multicentre, open-label, parallel-group, randomised, controlled, phase 3 trial. Lancet 403:2720–2731. https://doi.org/10.1016/S0140-6736(24)00594-4CrossRefPubMed

35.

Minsky 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 20:1167–1174. https://doi.org/10.1200/JCO.2002.20.5.1167CrossRefPubMed

36.

Modesto A, Tougeron D, Tremolières P et al (2023) Association of radiochemotherapy to immunotherapy in unresectable locally advanced oesophageal carciNoma-randomized phase 2 trial ARION UCGI 33/PRODIGE 67: the study protocol. BMC Cancer 23:966. https://doi.org/10.1186/s12885-023-11227-0CrossRefPubMedPubMedCentral

37.

Münch S, Pigorsch SU, Feith M et al (2017) Comparison of neoadjuvant chemoradiation with carboplatin/ paclitaxel or cisplatin/ 5‑fluoruracil in patients with squamous cell carcinoma of the esophagus. Radiat Oncol 12:182. https://doi.org/10.1186/s13014-017-0904-yCrossRefPubMedPubMedCentral

38.

NCCN Clinical practice Guidelines in Oncology Esophageal and esophagogastric junction cancers, v4.2023. https://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Zugegriffen: 25. Aug. 2024

39.

Obermannová R, Alsina M, Cervantes A et al (2022) Oesophageal cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol 33:992–1004. https://doi.org/10.1016/j.annonc.2022.07.003CrossRefPubMed

40.

Ott K, Lordick F, Molls M, Bartels H, Biemer E, Siewert JR (2009) Limited resection and free jejunal graft interposition for squamous cell carcinoma of the cervical oesophagus. Br J Surg 96:258–266. https://doi.org/10.1002/bjs.6437CrossRefPubMed

41.

Park S, Oh D, Choi YL, Chi SA, Kim K, Ahn MJ, Sun JM (2022) Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. Cancer 128:2148–2158. https://doi.org/10.1002/cncr.34176CrossRefPubMed

42.

Pasini F, de Manzoni G, Zanoni A et al (2013) Neoadjuvant therapy with weekly docetaxel and cisplatin, 5‑fluorouracil continuous infusion, and concurrent radiotherapy in patients with locally advanced esophageal cancer produced a high percentage of long-lasting pathological complete response: a phase 2 study. Cancer 119:939–945. https://doi.org/10.1002/cncr.27822CrossRefPubMed

43.

Pöttgen C, Hoffmann C, Gauler T et al (2023) Fractionation versus adaptation for compensation of target volume changes during online adaptive radiotherapy for bladder cancer: answers from a prospective registry. Cancers 15:4933. https://doi.org/10.3390/cancers15204933CrossRefPubMedPubMedCentral

44.

Shah MA, Bennouna J, Doi T et al (2021) KEYNOTE-975 study design: a phase III study of definitive chemoradiotherapy plus pembrolizumab in patients with esophageal carcinoma. Future Oncol 17:1143–1153. https://doi.org/10.2217/fon-2020-0969CrossRefPubMedPubMedCentral

45.

Song JH, Ko J, Min YW et al (2020) Comparison between percutaneous gastrostomy and self-expandable metal stent insertion for the treatment of malignant esophageal obstruction, after propensity score matching. Nutrients 12:2756. https://doi.org/10.3390/nu12092756CrossRefPubMedPubMedCentral

46.

Spigel DR, Greco FA, Meluch AA et al (2010) Phase I/II trial of preoperative oxaliplatin, docetaxel, and capecitabine with concurrent radiation therapy in localized carcinoma of the esophagus or gastroesophageal junction. J Clin Oncol 28:2213–2219. https://doi.org/10.1200/JCO.2009.24.8773CrossRefPubMed

47.

Sunde B, Lindblad M, Malmström M, Hedberg J, Lagergren P, Nilsson M (2021) Health-related quality of life one year after the diagnosis of oesophageal cancer: a population-based study from the Swedish national registry for oesophageal and gastric cancer. BMC Cancer 21:1277. https://doi.org/10.1186/s12885-021-09007-9CrossRefPubMedPubMedCentral

48.

Suntharalingam M, Winter K, Ilson D et al (2017) Effect of the addition of cetuximab to paclitaxel, cisplatin, and radiation therapy for patients with esophageal cancer: the NRG oncology RTOG 0436 phase 3 randomized clinical trial. JAMA Oncol 3:1520–1528. https://doi.org/10.1001/jamaoncol.2017.1598CrossRefPubMedPubMedCentral

49.

Takahashi K, Osaka Y, Ota Y, Watanabe T, Iwasaki K, Tachibana S, Nagakawa Y, Katsumata K, Tsuchida A (2020) Phase II study of docetaxel, cisplatin, and 5‑fluorouracil chemoradiotherapy for unresectable esophageal cancer. Anticancer Res 40:2827–2832. https://doi.org/10.21873/anticanres.14256CrossRefPubMed

50.

van Ruler MA, Peters FP, Slingerland M, Fiocco M, Grootenboers DA, Vulink AJ, Marijnen CA, Neelis KJ (2017) Clinical outcomes of definitive chemoradiotherapy using carboplatin and paclitaxel in esophageal cancer. Dis Esophagus 30:1–9. https://doi.org/10.1093/dote/dow033CrossRefPubMed

51.

Wang H, Liu X, Song Y, Yin P, Zou J, Shi X, Yin Y, Li Z (2023) Feasibility study of adaptive radiotherapy for esophageal cancer using artificial intelligence autosegmentation based on MR-Linac. Front Oncol 13:1172135. https://doi.org/10.3389/fonc.2023.1172135CrossRefPubMedPubMedCentral

52.

Wang L, Chen M, Kato K et al (2022) A phase 3 randomized, double-blind, placebo-controlled, multicenter, global study of durvalumab with and after chemoradiotherapy in patients with locally advanced, unresectable esophageal squamous cell carcinoma: KUNLUN. J Clin Oncol. https://doi.org/10.1200/JCO.2022.40.4_suppl.TPS373CrossRefPubMedPubMedCentral

53.

Wang X, Bai H, Li R et al (2023) High versus standard radiation dose of definitive concurrent chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis of randomized clinical trials. Radiother Oncol 180:109463. https://doi.org/10.1016/j.radonc.2023.109463CrossRefPubMed

54.

Xu Y, Dong B, Zhu W et al (2022) A phase III multicenter randomized clinical trial of 60 Gy versus 50 Gy radiation dose in concurrent chemoradiotherapy for inoperable esophageal squamous cell carcinoma. Clin Cancer Res 28:1792–1799. https://doi.org/10.1158/1078-0432.CCR-21-3843CrossRefPubMed

55.

Yang Y, Chen M, Xie J et al (2022) Treatment patterns and outcomes of elderly patients with potentially curable esophageal cancer. Front Oncol 12:778898. https://doi.org/10.3389/fonc.2022.778898CrossRefPubMedPubMedCentral

56.

You J, Zhu S, Li J et al (2023) High-dose versus standard-dose intensity-modulated radiotherapy with concurrent paclitaxel plus carboplatin for patients with thoracic esophageal squamous cell carcinoma: a randomized, multicenter, open-label, phase 3 superiority trial. Int J Radiat Oncol Biol Phys 115:1129–1137. https://doi.org/10.1016/j.ijrobp.2022.11.006CrossRefPubMed

57.

Zhu LL, Yuan L, Wang H et al (2015) A meta-analysis of concurrent chemoradiotherapy for advanced esophageal cancer. PLoS ONE 10:e128616. https://doi.org/10.1371/journal.pone.0128616CrossRefPubMedPubMedCentral

Titel: Definitive Radiochemotherapie des Ösophaguskarzinoms: etablierte Therapie und neue Standards
verfasst von: N. Guberina
M. Guberina
Y. Alberti
M. Stuschke
Publikationsdatum: 06.01.2025
Verlag: Springer Medizin
Schlagwörter: Ösophaguskarzinom
Ösophaguskarzinom
Strahlentherapie
Checkpoint-Inhibitoren
Checkpoint-Inhibitoren
Platinderivate
Onkologie
Erschienen in: Die Onkologie
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI: https://doi.org/10.1007/s00761-024-01645-5

Passend zum Thema

Lipid-Schutzschild-Komplex: Intensive Regeneration des Tränenfilms

Die neuen Bepanthen® Augentropfen Intense mit Lipidtechnologie bieten lang anhaltende Linderung, Befeuchtung und intensive Pflege. Hier mehr zur Behandlung von (chronisch) sehr trockenen Augen.

Falldiskussion: Hauttumoren und Nävi im Kindesalter

Prof. Dr. Henning Hamm, Würzburg, thematisierte anhand von Fallbeispielen Hauttumore und Nävi bei Kindern. Erfahren Sie hier unter anderem mehr über Differenzial-diagnosen beim infantilen Hämangiom.

Bepanthen® unterstützt bei vielen Indikationen die Regeneration der Haut

Content Hub

Bepanthen® Wund- und Heilsalbe wird heute wie bei der Einführung vor 70 Jahren erfolgreich bei kleinen Alltagsverletzungen eingesetzt. Moderne Forschung – Untersuchungen an Hautmodellen, Genexpressionsanalysen und klinische Studien – schafft darüber hinaus Evidenz für neue Anwendungsgebiete. So kann die Dexpanthenol-haltige Salbe heute z.B. zur Nachbehandlung einer Lasertherapie bei aktinischer Keratose oder Tattoo-Entfernung eingesetzt werden. Erfahren Sie hier mehr über moderne Forschung zu Bepanthen.

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Lipid-Schutzschild-Komplex: Intensive Regeneration des Tränenfilms

Falldiskussion: Hauttumoren und Nävi im Kindesalter

Bepanthen® unterstützt bei vielen Indikationen die Regeneration der Haut