INTRODUCTION: Mature results are presented from a phase II trial of postoperative concurrent chemoradiotherapy in patients with poor-prognosis cancer of the esophagus and gastroesophageal junction after primary surgical resection. METHODS: Resected patients with a pathologic stage of T3, N1, or M1a were eligible for this trial. Concurrent chemoradiotherapy was begun between 6 and 10 weeks after surgery and consisted of radiotherapy (1.8 Gy/d to a planned dose of 50.4-59.4 Gy), concurrent with two cycles of 5-fluorouracil (1000 mg/m/d) and cisplatin (20 mg/m/d), both given as 4-day continuous intravenous infusions during the first and fourth weeks of the radiation. RESULTS: Between 1995 and 2006, 50 patients were enrolled. The median age was 59 (range, 33-76) years, and most patients were male (86%), Caucasian (96%), and had undergone a transthoracic esophagogastrectomy (74%) for what proved to be a node positive (86%) adenocarcinoma (86%). Postoperative concurrent chemoradiotherapy was accompanied by neutropenia requiring hospitalization for fever in only four patients (8%) and no toxic deaths. With a median follow-up of 47 (range, 36-124) months, the Kaplan-Meier 4-year projected overall survival is 51%, freedom from recurrence 50%, distant metastatic control 56%, and locoregional control 86%. An earlier pathologic stage was the only predictor for a better outcome. CONCLUSIONS: This schedule of postoperative concurrent chemoradiotherapy has acceptable toxicity for patients with poor-prognosis esophageal and gastroesophageal junction cancer after surgery. Outcomes are better than historical results after surgery alone and justify further investigation of this approach.
INTRODUCTION: Mature results are presented from a phase II trial of postoperative concurrent chemoradiotherapy in patients with poor-prognosis cancer of the esophagus and gastroesophageal junction after primary surgical resection. METHODS: Resected patients with a pathologic stage of T3, N1, or M1a were eligible for this trial. Concurrent chemoradiotherapy was begun between 6 and 10 weeks after surgery and consisted of radiotherapy (1.8 Gy/d to a planned dose of 50.4-59.4 Gy), concurrent with two cycles of 5-fluorouracil (1000 mg/m/d) and cisplatin (20 mg/m/d), both given as 4-day continuous intravenous infusions during the first and fourth weeks of the radiation. RESULTS: Between 1995 and 2006, 50 patients were enrolled. The median age was 59 (range, 33-76) years, and most patients were male (86%), Caucasian (96%), and had undergone a transthoracic esophagogastrectomy (74%) for what proved to be a node positive (86%) adenocarcinoma (86%). Postoperative concurrent chemoradiotherapy was accompanied by neutropenia requiring hospitalization for fever in only four patients (8%) and no toxic deaths. With a median follow-up of 47 (range, 36-124) months, the Kaplan-Meier 4-year projected overall survival is 51%, freedom from recurrence 50%, distant metastatic control 56%, and locoregional control 86%. An earlier pathologic stage was the only predictor for a better outcome. CONCLUSIONS: This schedule of postoperative concurrent chemoradiotherapy has acceptable toxicity for patients with poor-prognosis esophageal and gastroesophageal junction cancer after surgery. Outcomes are better than historical results after surgery alone and justify further investigation of this approach.
Authors: James Welsh; Arya Amini; Anna Likhacheva; Jeremy Erasmus J; Daniel Gomez; Marta Davila; Reza J Mehran; Ritsuko Komaki; Zhongxing Liao; Wayne L Hofstetter; Jeffrey Lee H; Manoop S Bhutani; Jaffer A Ajani Journal: Curr Oncol Rep Date: 2011-06 Impact factor: 5.075
Authors: J M Bowen; I White; L Smith; A Tsykin; K Kristaly; S K Thompson; C S Karapetis; H Tan; P A Game; T Irvine; D J Hussey; D I Watson; D M K Keefe Journal: Support Care Cancer Date: 2015-03-27 Impact factor: 3.603
Authors: Vignesh Raman; Oliver K Jawitz; Soraya L Voigt; Chi-Fu J Yang; Thomas A D'Amico; David H Harpole Journal: J Surg Res Date: 2020-01-08 Impact factor: 2.192
Authors: Michael J McNamara; Lisa A Rybicki; Davendra Sohal; Daniela S Allende; Gregory M M Videtic; Cristina P Rodriguez; Kevin L Stephans; Sudish C Murthy; Siva Raja; Daniel Raymond; Denise I Ives; Joanna W Bodmann; David J Adelstein Journal: J Gastrointest Oncol Date: 2016-04