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Category: Volume 06 Issue 03 March 2018
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Title: Radical Chemoradiation and intraluminal brachytherapy boost in Squamous cell carcinoma of the Esophagus

Authors: Dr Arun Sankar Sudha MD, Dr Rakesh Kapoor MD, Dr Rakesh Kochhar DM

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.174

Abstract

Aim & Objective: To report the toxicity and outcome of intraluminal brachytherapy(ILBT) boost following chemoradiation (CRT) in the radical treatment of patients with Squamous cell carcinoma of the esophagus.

Patients & Methods: Patients with non-metastatic squamous cell carcinoma of the esophagus who were not candidates for surgery, were enrolled for this prospective observational study. They were treated with external radiation (44 Gy in 2Gy/day) with concurrent weekly cisplatin and 5-fluorouracil followed by brachytherapy boost. Acute and late toxicities, local control and overall survival were analyzed.

Result: Thirty patients with mean age of 53 years were enrolled in this study. Mean length of esophagus involved was 6cm. Two (6.6%) patients experienced grade 3 event – esophagitis, while 4(13.3%) patients developed esophageal perforation, of which 2 patients had gross residual disease, while two patients were locally disease free. Two patients (6.6%)died due to treatment related causes – esophageal perforation. Three (10%)patients developed grade3 stricture and symptomatic ulcers which required serial esophageal dilatation. Complete response as assessed at 3 months was 76.6%. The disease free survival and the overall survival at 1 year was 65.4% and 74.8% respectively.

Conclusion: In patients with Squamous cell carcinoma of the esophagus, radical chemoradiation with brachytherapy boost is well tolerated, with low incidence of severe complications and offers good survival.

Keywords: Esophageal neoplasms, Chemoradiotherapy, Brachytherapy, Squamous cell carcinoma.

References

  1. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer. 2013 [cited 2018 Jan 17]. Available from: http://globocan.iarc.fr/
  2. Esophageal cancer in India: Current status and future perspectives. Int J Adv Med Heal Res [Internet]. 2017 [cited 2018 Jan 17];4(1):5. Available from: http://www.ijamhrjournal.org/article.asp?issn=2349-4220;year=2017;volume=4;issue=1;spage=5;epage=10;aulast=Samarasam#ref23
  3. van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, Henegouwen MI van B, Wijnhoven BPL, et al. Preoperative Chemoradiotherapy for Esophageal or Junctional Cancer. N Engl J Med [Internet]. 2012;366(22):2074–84. Available from: http://www.nejm.org/doi/10.1056/NEJMoa1112088
  4. Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, et al. 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 [Internet]. 2002 Mar [cited 2018 Mar 14];20(5):1167–74. Available from: http://ascopubs.org/doi/10.1200/JCO.2002.20.5.1167
  5. Stahl M, Stuschke M, Lehmann N, Meyer H-J, Walz MK, Seeber S, et al. Chemoradiation With and Without Surgery in Patients With Locally Advanced Squamous Cell Carcinoma of the Esophagus. J Clin Oncol [Internet]. 2005 Apr [cited 2018 Jan 15];23(10):2310–7. Available from: http://ascopubs.org/doi/10.1200/JCO.2005.00.034
  6. Bedenne L, Michel P, Bouché O, Milan C, Mariette C, Conroy T, et al. Chemoradiation Followed by Surgery Compared With Chemoradiation Alone in Squamous Cancer of the Esophagus: FFCD 9102. J Clin Oncol [Internet]. 2007 Apr [cited 2018 Jan 15];25(10):1160–8. Available from: http://ascopubs.org/doi/10.1200/JCO.2005.04.7118
  7. Gaspar LE, Qian C, Kocha WI, Coia LR, Herskovic A, Graham M. A phase I/II study of external beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 92-07): Preliminary toxicity report. Int J Radiat Oncol Biol Phys. 1997;37(3):593–9.
  8. Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA, Byhardt R, et al. Chemoradiotherapy of Locally Advanced. 1999;281(17):1623–7.
  9. Wong RKS, Malthaner R. Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus. In: Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2006. Available from: http://dx.doi.org/10.1002/14651858.cd002092.pub2
  10. Gaspar LE, Winter K, Kocha WI, Coia LR, Herskovic A, Graham M. A Phase I/II study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207). Cancer [Internet]. 2000;88(5):988–95. Available from: http://dx.doi.org/10.1002/(sici)1097-0142(20000301)88:5%3C988::aid-cncr7%3E3.0.co
  11. Calais G, Dorval E, Louisot P, Bourlier P, Klein V, Chapet S, et al. Radiotherapy with high dose rate brachytherapy boost and concomitant chemotherapy for stages IIB and III esophageal carcinoma: Results of a pilot study. Int J Radiat Oncol Biol Phys. 1997;38(4):769–75.
  12. Tessa M, Rotta P, Ragona R, Sola B, Grassini M, Nassisi D, et al. Concomitant chemotherapy and external radiotherapy plus brachytherapy for locally advanced esophageal cancer: results of a retrospective multicenter study. Tumori [Internet]. 2005;91(5):406–14. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16459637
  13. Yorozu A, Toya K, Dokiya T. Long-term results of concurrent chemoradiotherapy followed by high dose rate brachytherapy for T2-3 N0-1 M0 esophageal carcinoma. Esophagus [Internet]. 2006;3(1):1–5. Available from: http://dx.doi.org/10.1007/s10388-006-0073-9
  14. Czito BG, Palta M, Willett CG. Results of the FFCD 9901 Trial in Early-Stage Esophageal Carcinoma : Is It Really About Neoadjuvant Therapy ? 2015;32(23):2398–400.
  15. Cheedella NKS, Suzuki A, Xiao L, Hofstetter WL, Maru DM, Taketa T, et al. Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol [Internet]. 2013 May 1 [cited 2018 Jan 16];24(5):1262–6. Available from: https://academic.oup.com/annonc/article-lookup/doi/10.1093/annonc/mds617
  16. Steffen T, Dietrich D, Schnider A, Kettelhack C, Huber O, Marti WR, et al. Recurrence Patterns and Long-Term Results After Induction Chemotherapy, Chemoradiotherapy, and Curative Surgery in Patients With Locally Advanced Esophageal Cancer. Ann Surg [Internet]. 2017 Jul 24 [cited 2018 Jan 16]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/28742685
  17. Noordman BJ, Shapiro J, Spaander MCW, Krishnadath KK, Noordman BJ. Accuracy of Detecting Residual Disease After Cross Neoadjuvant Chemoradiotherapy for Esophageal Cancer ( preSANO Trial ): JMIR Res Protoc. 2015 Jun 29;4(2):e79. doi: 10.2196/resprot.4320.

Corresponding Author

Dr Arun Sankar Sudha, MD

Division of Radiation oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India

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