Patterns of failure following tri-modality therapy for locally advanced esophageal cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 203-203
Author(s):  
Talha Shaikh ◽  
Mark A. Zaki ◽  
Michael M. Dominello ◽  
Elizabeth Handorf ◽  
Andre A. Konski ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Metastatic Disease ◽  
Locally Advanced ◽  
Post Treatment ◽  
Advanced Esophageal Cancer ◽  
Patterns Of Failure ◽  
Cancer Data ◽  
Locally Advanced Esophageal Cancer

203 Background: Although tri-modality therapy is an acceptable standard of care in patients with locally advanced esophageal cancer, data regarding patterns of failure is lacking. We report bi-institutional patterns of failure experience treating patients using tri-modality therapy. Methods: Following IRB approval, we retrospectively reviewed all pts who underwent chemoradiation followed by esophagectomy at two NCI-designated cancer centers from 2000-2013. Patient and treatment factors were analyzed for failure patterns. First failure sites were categorized as local, regional nodal, or distant. Statistical analysis was performed using Fisher’s exact test and non-parametric Wilcoxon rank-sum test. Results: A total of 132 patients met the inclusion criteria with a median age of 62 (range 36-80) and median follow-up of 28 months (range 4-128). The majority of patients had T3 (82%), N1 (64%), or M0/M1a (92%) disease. At the time of last follow-up there were a total of 6 (4.5%) local, 13 (10%) regional nodal, and 32 (23.5%) distant failures. Local failure was correlated with fewer lymph nodes assessed (p=0.01) and close or positive margins (p<0.01). Regional nodal failure was correlated with fewer lymph nodes assessed (p<0.01) and smaller pre-treatment tumor size (p=0.04). Distant recurrence was correlated with post-treatment nodal stage (p<0.01), peri-neural invasion (p=0.03), negative margins (p=0.02), ulceration (p=0.02), incomplete response (p<0.01), post-treatment PET SUV (p=0.05), 3D-CRT (0.053), metastatic disease at diagnosis (p<0.01) and post-treatment metastatic disease (p<0.01). No other patient, tumor, or treatment factor was correlated with treatment failure. Conclusions: Per our bi-institutional experience, patient, tumor, and treatment factors may predict for failure in patients undergoing tri-modality therapy for locally advanced esophageal cancer. Further data is needed to identify patterns of failure in these patients.

scholarly journals Radical chemoradiotherapy for patients with locally advanced esophageal cancer. Long-term follow up of an ambispective study

2017 ◽  
Vol 28 ◽  
pp. iii29
Author(s):  
Milana Bergamino Sirven ◽  
Ana Ortega Franco ◽  
Gloria Hormigo ◽  
Luisa Aliste ◽  
Isabel Padrol ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Advanced Esophageal Cancer ◽  
Long Term Follow Up ◽  
Locally Advanced Esophageal Cancer

scholarly journals Randomized Phase IIB Trial of Proton Beam Therapy Versus Intensity-Modulated Radiation Therapy for Locally Advanced Esophageal Cancer

2020 ◽  
Vol 38 (14) ◽  
pp. 1569-1579 ◽  
Author(s):  
Steven H. Lin ◽  
Brian P. Hobbs ◽  
Vivek Verma ◽  
Rebecca S. Tidwell ◽  
Grace L. Smith ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Therapy ◽  
Interim Analysis ◽  
Locally Advanced ◽  
Intensity Modulated Radiation Therapy ◽  
Proton Beam Therapy ◽  
Advanced Esophageal Cancer ◽  
Intensity Modulated ◽  
Locally Advanced Esophageal Cancer

PURPOSE Whether dosimetric advantages of proton beam therapy (PBT) translate to improved clinical outcomes compared with intensity-modulated radiation therapy (IMRT) remains unclear. This randomized trial compared total toxicity burden (TTB) and progression-free survival (PFS) between these modalities for esophageal cancer. METHODS This phase IIB trial randomly assigned patients to PBT or IMRT (50.4 Gy), stratified for histology, resectability, induction chemotherapy, and stage. The prespecified coprimary end points were TTB and PFS. TTB, a composite score of 11 distinct adverse events (AEs), including common toxicities as well as postoperative complications (POCs) in operated patients, quantified the extent of AE severity experienced over the duration of 1 year following treatment. The trial was conducted using Bayesian group sequential design with three planned interim analyses at 33%, 50%, and 67% of expected accrual (adjusted for follow-up). RESULTS This trial (commenced April 2012) was approved for closure and analysis upon activation of NRG-GI006 in March 2019, which occurred immediately prior to the planned 67% interim analysis. Altogether, 145 patients were randomly assigned (72 IMRT, 73 PBT), and 107 patients (61 IMRT, 46 PBT) were evaluable. Median follow-up was 44.1 months. Fifty-one patients (30 IMRT, 21 PBT) underwent esophagectomy; 80% of PBT was passive scattering. The posterior mean TTB was 2.3 times higher for IMRT (39.9; 95% highest posterior density interval, 26.2-54.9) than PBT (17.4; 10.5-25.0). The mean POC score was 7.6 times higher for IMRT (19.1; 7.3-32.3) versus PBT (2.5; 0.3-5.2). The posterior probability that mean TTB was lower for PBT compared with IMRT was 0.9989, which exceeded the trial’s stopping boundary of 0.9942 at the 67% interim analysis. The 3-year PFS rate (50.8% v 51.2%) and 3-year overall survival rates (44.5% v 44.5%) were similar. CONCLUSION For locally advanced esophageal cancer, PBT reduced the risk and severity of AEs compared with IMRT while maintaining similar PFS.

52 SHORT-TERM OUTCOMES OF RAMIE VERSUS TLE FOR LOCALLY ADVANCED ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY: A PROPENSITY SCORE-MATCHED ANALYSIS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
X Guo ◽  
H Jiang ◽  
B Li ◽  
Y Sun ◽  
R Hua ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Nodes ◽  
Operative Time ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Perioperative Outcomes ◽  
Advanced Esophageal Cancer ◽  
Short Term ◽  
Significant Difference ◽  
Locally Advanced Esophageal Cancer

Abstract   This study aimed to compare the short-term outcomes of esophagectomy (RAMIE) versus thoracolaparoscopic esophagectomy (TLE) for patients undergoing neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal cancer in a propensity matched cohort. Methods Data for consecutive patients receiving nCRT plus RAMIE or TLE were collected prospectively from February 2016 to December 2019. Baseline characteristics and perioperative outcomes of the RAMIE and TLE groups were retrospectively compared. Results After propensity matching, 48 pairs were identified. The conversion rate to open thoracotomy was comparable in RAMIE and TLE (4.2% vs 6.3%, P = 1). Median operative time in RAMIE was significantly shorter than TLE (237 vs 271 min, P &lt; 0.001). Compared with TLE group, the median number of dissected lymph nodes was higher in RAMIE group at the left recurrent laryngeal nerve (RLN) area [2 (1–3) vs 1 (0–2), P = 0.014], total RLN area [4.5 (2.0–7.0) vs 2.5 (1.0–5.0), P = 0.008], and thoracic area [10.5(7.0–16.0) vs 8.5(5.0–14.5), P = 0.049]. There was no significant difference in pneumonia, leakage, and vocal cord paralysis. Conclusion Compared to traditional TLE, RAMIE can achieve more lymph nodes yield at the RLN region and shorter operative time for the patients undergoing nCRT with comparable postoperative outcomes.

179 FEASIBILITY AND ONCOLOGICAL OUTCOME OF CHEMORADIATION WITH INTENSIFIED IMRT IN LOCALLY ADVANCED ESOPHAGEAL CANCER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Innocente ◽  
F Navarria ◽  
R Petri ◽  
E Palazzari ◽  
M Gigante ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tumor Volume ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Oncological Outcome ◽  
Advanced Esophageal Cancer ◽  
Free Survival ◽  
Ecog Ps ◽  
Locally Advanced Esophageal Cancer

Abstract   To assess safety, feasibility and efficacy of an intensified preoperative IMRT and concomitant carboplatin and paclitaxel-based chemotherapy (Carbo/Tax CT) in patients (pts) with locally advanced esophageal cancer (LAEC) treated at our Institution. Methods a retrospective analysis of toxicity (CTCAE 4.03), progression free survival (PFS) and overall survival (OS) of pts affected by LAEC, treated with preoperative intensified radiotherapy (IMRT) and weekly concurrent carboplatin and paclitaxel-based chemotherapy (CT) according to the CROSS trial, between February 2016 and October 2019, at the Centro di Riferimento Oncologico, Aviano (CRO). Results Sixty-nine consecutive pts, 57(82.6%) males, were treated. The median age was 69 yrs (38–85), the ECOG PS 0–2. All pts underwent concurrent chemoradiotherapy, IMRT technique, 45 Gy/25 to PTV1 (primary tumor volume + regional nodes), a simultaneous boost from 52.5Gy to 54Gy to PTV2 (gross tumor volume) and weekly concurrent carboplatin (AUC2) and paclitaxel (50 mg/m2). Induction CT was administered to 17 pts. All pts completed RT with median 4 (1–5) CT cycles. Median follow-up was 8 months (4–17); 2-yr PFS and OS were 49.0% and 80.3%, respectively. At 2 yrs, local recurrence rate was 8.4% (CI 95%: 2.6%–18.8%). Conclusion Preoperative intensified IMRT with concomitant Carbo/Tax CT in pts with LAEC appears safe and feasible with promising oncological outcome and needs to be confirmed in a larger series of pts.

Locally advanced esophageal cancer: Actual 5-year survival comparing neoadjuvant and adjuvant chemoradiation.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 149-149
Author(s):  
C. S. Davis ◽  
J. R. Johns ◽  
G. J. Abood ◽  
T. A. Baker ◽  
D. Zank ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Advanced Esophageal Cancer ◽  
Early Esophageal Cancer ◽  
Ivor Lewis ◽  
Perioperative Morbidity ◽  
Ivor Lewis Esophagectomy ◽  
Social Security Death Index ◽  
Locally Advanced Esophageal Cancer

149 Background: Patients undergoing esophagectomy for locally advanced esophageal cancer are often candidates for chemoradiotherapy (CRT). It is unclear if there is a survival advantage for CRT when administered in the neoadjuvant (NCRT) versus the adjuvant (ACRT) setting. We report a single institution experience with actual long-term follow-up of patients with resected esophageal cancer treated with NCRT or ACRT. Methods: Following IRB approval, a retrospective review of 123 patients undergoing Ivor-Lewis esophagectomy between January 1, 1990 through December 31, 2001 was conducted. Clinicopathologic variables were analyzed, and survival was determined from hospital records, the Social Security Death Index, and direct patient follow-up. All patients were followed for at least five years, and survival was assessed by Kaplan-Meier analysis. Results: Of the 123 patients, 65 had surgery alone for early esophageal cancer and were excluded from the analysis. Of the remaining 58, 31 received NCRT and 27 received ACRT. There was no difference between groups for length of operation, blood loss, or complication rate. With all patients having at least 5 years of follow-up, the overall 1-year survival was 65% and 67% (p=0.866), 3-year survival was 42% and 33% (p=0.508), and 5-year survival was 26% and 22% (p=0.755) for the NCRT and ACRT groups, respectively (Table 1). Among those in the NCRT group, patients with a complete or partial response (n=20) had an improved 1-year survival as compared to those with no response at all (n=11; p=0.025). However, this difference did not persist at 3 and 5-years (p=0.224 and p=0.896, respectively). Conclusions: In this study, all patients with locally advanced esophageal carcinoma who underwent Ivor-Lewis esophagectomy with either NCRT or ACRT were followed for at least 5 years. Not only was there no difference in perioperative morbidity or mortality, but the overall 5-year survival was almost identical between groups. Therefore, as NCRT may be better tolerated and more easily administered, we advocate its use over ACRT in those with locally advanced esophageal cancer. No significant financial relationships to disclose.

Factors associated with local-regional failure after definitive chemoradiation for locally advanced esophageal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14669-e14669
Author(s):  
Arya Amini ◽  
James Welsh ◽  
Pamela Allen ◽  
Lianchun Xiao ◽  
Akihiro Suzuki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Radiation Treatment ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Standardized Uptake Value ◽  
Disease Recurrence ◽  
Post Treatment ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiation ◽  
Locally Advanced Esophageal Cancer

e14669 Background: Esophageal cancer is often treated with a trimodality approach (chemotherapy and radiation followed by surgery). However a significant proportion of such patients achieve a clinical complete response (cCR) following chemoradiation alone. We retrospectively analyzed patients who reached cCR after definitive chemoradiation for locally advanced esophageal cancer to identify clinical predictors of local disease recurrence. Methods: We identified 141 patients who obtained initial cCR after definitive chemoradiation for esophageal cancer from January 2002 through January 2009. The initial response to treatment was assessed by endoscopic evaluation and biopsy results, with cCR defined as having no evidence of disease present. Patterns of failure were categorized as in-field (within the planned treatment volume [PTV]), outside the radiation treatment field, or both. Results: At a median follow-up of 22 months (range 6-87 months), 77 patients (55%) had experienced disease recurrence. Most first failures (32, or 23%) were outside the radiation field, followed by 30 (21%) within the field and 15 (11%) were both. In multivariate analysis, in-field failure after cCR was associated with a post-treatment standardized uptake value (SUV) on positron emission tomography of >3.5 (odds ratio [OR] 4.93, p=0.022), squamous histology (OR 0.07, p=0.010), and borderline for T3/T4 disease (OR 10.25, p=0.055). All failures, in-field and out-of-field, correlated with T3/T4 disease (OR 11.61, p=0.015), N1 disease (OR 5.07, p=0.010), pretreatment SUV >10 (OR 4.00, p=0.048), and post-treatment SUV >3.5 (OR 3.59, p=0.052). Conclusions: Clinical characteristics can be used to predict failure patterns after definitive chemoradiation. Such risk-assessment strategies can help individualize therapy.

Chemoradiotherapy for locally advanced esophageal cancer using carboplatin, paclitaxel.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14666-e14666
Author(s):  
Jodie E. Battley ◽  
Margaret O'Keeffe ◽  
Erica Mulvihill ◽  
Seamus O'Reilly ◽  
Michael William Bennett ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Locally Advanced ◽  
Squamous Carcinoma ◽  
Lymph Node Involvement ◽  
Advanced Esophageal Cancer ◽  
Grade 3 ◽  
Repeat Imaging ◽  
Locally Advanced Esophageal Cancer ◽  
Group Grade

e14666 Background: Localized esophageal adenocarcinoma is usually treated with multi-modality therapy, i.e., chemotherapy or chemoradiotherapy (CRT) followed by surgery. Standard treatment for localized squamous cell carcinoma is controversial as definitive CRT can offer the same overall survival as CRT followed by surgery. Cisplatin and infusional 5FU is the accepted chemotherapy in combination with RT. However this regimen is cumbersome to administer and is associated with significant toxicities. Based on recent data combining weekly paclitaxel with radiotherapy in both the neoadjuvant and definitive settings we report our early experience with this regimen. Methods: All patients (pts) were staged with CT, EUS and PET/CT. Pts with localized, operable or inoperable disease were included. CRT consisted of paclitaxel 50mg/m2 and carboplatin AUC = 2 on days 1, 8, 15, 22, 29, 35 with concurrent RT (5 days/wk, 41.4-50.4Gy). Results: From December 2010 to January 2012, 24 pts: male/female 20/4, median age 67 yrs (29-88), adeno/squamous carcinoma 14/10, lymph node involvement (21pts) were treated. 13 pts treated with neoadjuvant (NA) intent, 11 pts underwent definitive CRT. In the NA group grade 3/4 toxicities were non-hematologic: cardiac (1pt), fatigue (1pt), 2 pts died from progression of disease prior to surgery. Eight pts have undergone surgery (3 awaited). RO resection rate 87.5%, 1 pt had a pCR, 4 pts had a near pCR. At 3mth follow-up 3 pts had no clinical or radiological evidence of disease, 5 pts await repeat imaging. In the definitive group grade 3/4 toxicities included hematologic: neutropenic fever (1pt), non-hematologic: esophagitis (3pts). At 3mth follow-up 7 pts have stable disease, 4 pts await repeat imaging. Dysphagia improved in 21 pts, worsened in 3 pts, and 5 pts required a feeding tube (4 prior to CRT). Conclusions: Carboplatin and paclitaxel combined with radiotherapy is a tolerable regimen in either the neo-adjuvant or definitive setting for locally advanced esophageal cancer. Rates of toxicity compare favorably to standard cisplatin and infusional 5FU. Prospective data with long-term follow-up using this regimen have been reported in the neo-adjuvant setting and are awaited in the definitive setting.

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