Dose-escalated radiotherapy with PET/CT based treatment planning in combination with induction and concurrent chemotherapy in locally advanced (uT3/T4) squamous cell cancer of the esophagus: mature results of a phase I/II trial.
Abstract | BACKGROUND: This prospective phase I/II trial assessed feasibility and efficacy of dose-escalated definitive chemoradiation after induction chemotherapy in locally advanced esophageal cancer. Primary study endpoint was loco-regional progression-free survival at 1 year. METHODS: Eligible patients received 2 cycles of induction chemotherapy with irinotecan, folinic acid and 5-fluorouracil weekly and cisplatin every 2 weeks (weeks 1-6, 8-13) followed by concurrent chemoradiation with cisplatin and irinotecan (weeks 14, 15, 17, 18, 20). Radiotherapy dose escalation was performed in three steps (60 Gy, 66 Gy, 72 Gy) using conventional fractionation, planning target volumes were delineated with the aid of 18F-FDG-PET/CT scans. During follow-up, endoscopic examinations were performed at regular intervals. RESULTS: Between 09/2006 and 02/2010, 17 patients were enrolled (male/female:13/4, median age: 59 [range 48-66] years, stage uT3N0/T3N1/T4N1: 4/12/1). One patient progressed during induction chemotherapy and underwent surgery. Of 16 patients treated with definitive chemoradiotherapy, 9 (56%) achieved complete response after completion of chemoradiation. One-, 2-, 3- and 5-year overall survival rates (OS) were 77% [95%CI: 59-100], 53% [34-83], 41% [23-73], and 29% [14-61], respectively. Loco-regional progression-free survival at 1, 3, and 5 years was 59% [40-88], 35% [19-67], and 29% [14-61], corresponding cumulative incidences of loco-regional progressions were 18% [4-39%], 35% [14-58%], and 41% [17-64%]. No treatment related deaths occurred. Grade 3 toxicities during induction therapy were: neutropenia (41%), diarrhoea (41%), during combined treatment: neutropenia (62%) and thrombocytopenia (25%). CONCLUSIONS:
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Authors | C Pöttgen, E Gkika, M Stahl, J Abu Jawad, T Gauler, S Kasper, T Trarbach, K Herrmann, N Lehmann, K-H Jöckel, H Lax, M Stuschke |
Journal | Radiation oncology (London, England)
(Radiat Oncol)
Vol. 16
Issue 1
Pg. 59
(Mar 23 2021)
ISSN: 1748-717X [Electronic] England |
PMID | 33757534
(Publication Type: Clinical Trial, Phase I, Clinical Trial, Phase II, Journal Article)
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Topics |
- Aged
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Chemoradiotherapy
(adverse effects, methods)
- Esophageal Neoplasms
(mortality, therapy)
- Esophageal Squamous Cell Carcinoma
(mortality, therapy)
- Female
- Humans
- Induction Chemotherapy
- Male
- Middle Aged
- Positron Emission Tomography Computed Tomography
(methods)
- Prospective Studies
- Radiotherapy Dosage
- Radiotherapy Planning, Computer-Assisted
(methods)
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