Vanita Noronha1, Amit Joshi1, Vijay M Patil1, Nilendu Purandare2, Sabita Jiwnani3, Sarbani Ghosh-Laskar4, Dipti Nakti1, Bhavesh Bandekar1, Kumar Prabhash5. 1. Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India. 2. Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India. 3. Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India. 4. Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. 5. Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India. kumarprabhashtmh@gmail.com.
Abstract
PURPOSE: Esophageal cancer with tracheobronchial involvement (TBI) has a poor prognosis. Radical therapy carries the risk of inducing tracheoesophageal fistula (TEF) and treatment-related mortality. Induction chemotherapy followed by reassessment for radical therapy may decrease morbidity and improve outcome. METHODS: This is a retrospective analysis of esophageal cancer patients with TBI who received induction chemotherapy. Airway involvement was defined as bronchoscopic appearance of a bulge into the lumen, restricted or immobile mucosa, frank infiltration, TEF, or stridor, which was clinically due to airway obstruction from the esophageal lesion. RESULTS: Eighty-three patients were included over 5 years; 97.6 % had squamous histology. All patients received taxane and platinum combination induction chemotherapy; 90.5 % of patients received chemotherapy without dose delays, and 77.8 % patients did not require a dose reduction or modification. The 31.7 % patients had a clinically significant ≥grade 3 toxicity. The objective response rate was 67 % among the patients who underwent restaging scans following induction chemotherapy; 79.5 % of the patients could receive radical intent therapy, either concurrent chemoradiotherapy, or radiation alone, or surgery in one patient. The TEF complication rate was 6 % during the course of therapy. At a median follow-up of 28 months in surviving patients, the estimated median PFS was 8 months (95 % CI 5.5-10.5) and the estimated median OS was 17 months (95 % CI 5.6-28.4). Patients who received radical therapy had a significantly better PFS and OS, p = 0.000. CONCLUSIONS: Induction chemotherapy may improve the outcome of patients with esophageal cancer involving the airway and may help select patients for curative treatment and lower the risk of TEF development.
PURPOSE:Esophageal cancer with tracheobronchial involvement (TBI) has a poor prognosis. Radical therapy carries the risk of inducing tracheoesophageal fistula (TEF) and treatment-related mortality. Induction chemotherapy followed by reassessment for radical therapy may decrease morbidity and improve outcome. METHODS: This is a retrospective analysis of esophageal cancerpatients with TBI who received induction chemotherapy. Airway involvement was defined as bronchoscopic appearance of a bulge into the lumen, restricted or immobile mucosa, frank infiltration, TEF, or stridor, which was clinically due to airway obstruction from the esophageal lesion. RESULTS: Eighty-three patients were included over 5 years; 97.6 % had squamous histology. All patients received taxane and platinum combination induction chemotherapy; 90.5 % of patients received chemotherapy without dose delays, and 77.8 % patients did not require a dose reduction or modification. The 31.7 % patients had a clinically significant ≥grade 3 toxicity. The objective response rate was 67 % among the patients who underwent restaging scans following induction chemotherapy; 79.5 % of the patients could receive radical intent therapy, either concurrent chemoradiotherapy, or radiation alone, or surgery in one patient. The TEF complication rate was 6 % during the course of therapy. At a median follow-up of 28 months in surviving patients, the estimated median PFS was 8 months (95 % CI 5.5-10.5) and the estimated median OS was 17 months (95 % CI 5.6-28.4). Patients who received radical therapy had a significantly better PFS and OS, p = 0.000. CONCLUSIONS: Induction chemotherapy may improve the outcome of patients with esophageal cancer involving the airway and may help select patients for curative treatment and lower the risk of TEF development.
Authors: A Ohtsu; N Boku; K Muro; K Chin; M Muto; S Yoshida; M Satake; S Ishikura; T Ogino; Y Miyata; S Seki; K Kaneko; A Nakamura Journal: J Clin Oncol Date: 1999-09 Impact factor: 44.544
Authors: Joel Tepper; Mark J Krasna; Donna Niedzwiecki; Donna Hollis; Carolyn E Reed; Richard Goldberg; Krystyna Kiel; Christopher Willett; David Sugarbaker; Robert Mayer Journal: J Clin Oncol Date: 2008-03-01 Impact factor: 44.544