PO-075: Induction chemotherapy in locally advanced hypopharynx cancer: treatment outcomes and role of nutritional status

148 Background: Dysphagia is one of the most common presenting symptoms in esophageal cancer (EC) and can lead to significant nutritional decline, which is associated with increased toxicity and poor outcomes. Invasive feeding tubes or endoscopic stents are frequently used to improve nutrition in this setting. We evaluated the role of induction chemotherapy prior to concurrent chemoradiation as presurgical treatment in improving dysphagia. Methods: Retrospective analysis of 4 prospective studies conducted at MSKCC with induction chemotherapy followed by concurrent chemoradiation and surgery in locally advanced esophageal/GEJ cancer. Regimens included cisplatin/paclitaxel, cisplatin/irinotecan, and cisplatin/irinotecan/bevacizumab. Dysphagia was graded prospectively using a validated dysphagia scale. Response of dysphagia and nutritional status to induction chemotherapy was evaluated. Results: Of 161 patients (pts) undergoing induction chemotherapy, [median age 59(21-76), KPS 90 (70-100), 77% adenocarcinoma], 121 (76%) had dysphagia, with 59(37%) having grade 2 dysphagia or higher (20% Stage II, 80% Stage III). 6(4%) required EGD dilatation/stent and none required feeding tube placement prior to treatment. 22% patients had>10% body weight loss prior to treatment and average weight loss in all pts was 4.3kg. After induction chemotherapy, 104 (64%) had improvement in dysphagia. This was associated with a weight gain in 42% of pts. Only 7(4%) had worsening dysphagia after induction chemotherapy: 4/7 required feeding tubes (2% of all pts), 2/7 underwent endoscopic dilatation or stent (1% of all pts). 6/7 of these pts with worsening dysphagia had poor short term outcomes after induction treatment: 2/7 progressive disease, 3/7 unresectable at surgery, 1/7 post-operative death. Conclusions: Induction chemotherapy prior to concurrent chemoradiation for locally advanced esophageal cancer can effectively improve swallowing and nutritional status, while mitigating need for feeding tubes or stents in patients with significant dysphagia. Post-induction dysphagia may be prognostic and merits further investigation.

Download Full-text

Chemoradiotherapy in the Management of Locally Advanced Pancreatic Carcinoma: A Qualitative Systematic Review

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.7921 ◽

2009 ◽

Vol 27 (13) ◽

pp. 2269-2277 ◽

Cited By ~ 168

Author(s):

Florence Huguet ◽

Nicolas Girard ◽

Clotilde Séblain-El Guerche ◽

Christophe Hennequin ◽

Françoise Mornex ◽

...

Keyword(s):

Systematic Review ◽

Pancreatic Carcinoma ◽

Induction Chemotherapy ◽

Randomized Trials ◽

Locally Advanced ◽

Phase Iii ◽

Level Of Evidence ◽

Qualitative Systematic Review ◽

Survival Level

PurposePancreatic carcinoma is one of the leading causes of cancer-related mortality. At time of diagnosis, 30% of patients present with a locally advanced unresectable but nonmetastatic pancreatic carcinoma (LAPC). The French program Standards, Options, and Recommendations was promoted to conduct a qualitative systematic review to evaluate the role of radiotherapy in patients with LAPC.MethodsA search to identify eligible studies was undertaken using the MEDLINE database. All phase III randomized trials and systematic reviews evaluating the role of radiotherapy in LAPC were included, together with some noncontrolled studies if no phase III trials were retrieved. The quality and clinical relevance of the studies were evaluated using validated checklists, which allowed associating each result with a level of evidence.ResultsTwenty-one studies were included, as follows: two meta-analyses, 13 randomized trials, and six nonrandomized trials. Chemoradiotherapy increases overall survival when compared with best supportive care (level of evidence C) or with exclusive radiotherapy (level B1), but is more toxic (level B1). Chemoradiotherapy is not superior to chemotherapy in terms of survival (level B1) and increases toxicity (level A). Recent data favor limited irradiation to the tumor volume (level C). Fluorouracil is still the reference chemotherapy in association with radiotherapy (level B1). Induction chemotherapy before chemoradiotherapy improves survival (level C).ConclusionNo standard treatment exists, but there are two options for treatment of LAPC; these are gemcitabine-based chemotherapy and chemoradiotherapy. Induction chemotherapy followed by a chemoradiotherapy is a promising strategy for selection of patients without early metastatic/progressing disease.

Download Full-text