Feasibility and Oncological Outcome of Preoperative Chemoradiation With IMRT Dose Intensification for Locally Advanced Esophageal and Gastroesophageal Cancer
| Autor: | Antonio Martino, E. Palazzari, Jerry Polesel, Claudio Belluco, Giovanni Franchin, Luisa Foltran, Roberto Innocente, Massimo Vecchiato, Paolo Ubiali, Carlotta Benedetta Colombo, Roberto Petri, Antonino De Paoli, Antonio Ziccarelli, Arben Lleshi, Angela Buonadonna, F. Navarria, Loredana Barresi, A. Lauretta, Dino Tonin, M. Gigante |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Cancer Research Urology lcsh:RC254-282 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine medicine esophageal cancer 030212 general & internal medicine Prospective cohort study dose intensification Original Research gastroesophageal junction cancer business.industry Mortality rate Cancer Esophageal cancer lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens intensity-modulated radiotherapy medicine.disease Carboplatin Regimen Paclitaxel chemistry Oncology simultaneous integrated boost 030220 oncology & carcinogenesis Toxicity business |
| Zdroj: | Frontiers in Oncology Frontiers in Oncology, Vol 11 (2021) |
| ISSN: | 2234-943X |
| DOI: | 10.3389/fonc.2021.626275 |
| Popis: | PurposeTo explore the feasibility and efficacy of a dose intensification with Intensity Modulated Radiation Therapy and Simultaneous Integrated Boost (IMRT-SIB) in locally advanced esophageal and gastroesophageal cancer (GEJ).Methods and MaterialsWe retrospectively analyzed a series of 69 patients with esophageal or GEJ cancer treated at our Institute, between 2016 and 2019, with preoperative IMRT and SIB up to 52.5–54 Gy in 25 fractions in 5 weeks and concurrent carboplatin (AUC2) and paclitaxel (50 mg/m2), as in the CROSS regimen.ResultsAll patients completed the planned IMRT–SIB program with a median of four (range 1–5) cycles of concurrent paclitaxel/carboplatin. Compliance to IMRT–SIB was 93%, whereas 54% of patients received four to five cycles and 87% at least three cycles of concurrent carboplatin/paclitaxel. Grade 3 toxicity was reported in 19% of patients. Complete clinical response (cCR) was achieved in 48%, and 13% had disease progression after chemoradiation (CRT). Overall, 49% of patients underwent surgery; reasons for non-operation included cCR in cervical tumor location (10%) or cCR and patient decision (13%). A pathologic complete response (pCR) was achieved in 44% of resected patients. Postoperative complications and mortality rates were 21 and 6%, respectively. At a median follow-up of 12 months (6–25), 2-year overall and progression-free (PFS) survival rates were 81 and 54%, respectively. No difference in PFS by histologic type in operated patients was reported. Non-operated cCR patients had higher PFS, including cervical locations and selected cCR patients who decided for non-operation (75 vs 30%, p < 0.01).ConclusionThe study reported favorable results in safety and feasibility of the IMRT–SIB dose intensification in our preoperative CRT program. The toxicity was acceptable, allowing a high compliance to intensified radiation doses with dose reduction of concurrent paclitaxel/carboplatin in some patients. The high rate of cCR and pCR suggested this intensified program is effective in the preoperative CRT and, for selected responsive patients, in the non-operative approach to esophageal and GEJ cancer. The 2-year survival rates were promising. A prospective study is being planned to confirm these observations. |
| Databáze: | OpenAIRE |
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