scholarly journals Involved-field irradiation in definitive chemoradiotherapy for T4 squamous cell carcinoma of the esophagus

2016 ◽  
Vol 23 (2) ◽  
pp. 131 ◽  
Author(s):  
M. Li ◽  
F. Zhao ◽  
X. Zhang ◽  
F. Shi ◽  
H. Zhu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Therapeutic Option ◽  
Locally Advanced ◽  
Target Volume ◽  
Carcinoma Of The Esophagus ◽  
Failure Patterns ◽  
Involved Field ◽  
Nodal Failure

Objectives Definitive concurrent chemoradiotherapy (ccrt) is currently a therapeutic option for locally advanced esophageal cancer. However, clinical practice differs with respect to the target volume for irradiation. The purpose of the present study was to analyze failure patterns and survival, and to determine the feasibility of using involved-field irradiation (ifi) with concurrent chemotherapy for T4 squamous cell carcinoma (scc) of the esophagus.Methods Between January 2003 and January 2013, 56 patients with clinical T4M0 scc of the esophagus received ccrt using ifi. The radiation field included the primary tumour and clinically involved lymph nodes. Target volumes and sites of failure were analyzed, as were treatment-related toxicity and survival time.Results In this 56-patient cohort, 13 patients (23.2%) achieved a complete response, and 21 (37.5%) achieved a partial response, for a total response rate of 60.7%. The major toxicities experienced were leucocytopenia and esophagitis, with 14 patients (25.0%) experiencing grade 3 toxicities. At a median follow-up of 34 months, 48 patients (85.7%) had experienced failure: 39 (69.6%) in-field, 7 (12.5%) elective nodal, and 19 (33.9%) distant. Only 1 patient (1.8%) experienced isolated elective nodal failure. The 1-, 2-, and 3-year survival rates were 39.3%, 21.4%, and 12.5% respectively.Conclusions For patients with T4M0 scc of the esophagus, definitive ccrt using ifi resulted in an acceptable rate of isolated elective nodal failure and an overall survival comparable to that achieved with elective nodal irradiation. A limited radiation therapy target volume, including only clinically involved lesions, would therefore be a feasible choice for this patient subgroup.

PS02.232: BASALOID CARCINOMA OF THE ESOPHAGUS: MULTIMODAL APPROACH

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 188-188
Author(s):  
Marta De Vega ◽  
Carlos Miliani ◽  
Juan Rodriguez Vitoria ◽  
Juan Antonio Martinez-Piñeiro ◽  
Fernando Pereira
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Multimodal Treatment ◽  
Locally Advanced ◽  
Distal Esophagus ◽  
Lower Esophagus ◽  
Carcinoma Of The Esophagus ◽  
Basaloid Cell ◽  
Poorly Differentiated

Abstract Background Basaloid cell carcinoma of the esophagus (BSCCE) is a rare (0.07–4%) poorly-differentiated variety of squamous cell carcinoma (SCC), more aggressive and with a worse prognosis than typical SCC. There are no published studies on the best therapeutic option for these tumors or on of the effectiveness of Neoadjuvant chemoradiotherapie; so there is no standard treatment. We describe the characteristics and the therapeutic strategy applied to a patient with an avanced basaloid squamous cell carcinoma of the distal esophagus. Methods A 70-year-old woman with dysphagia and severe malnutrition was diagnosed with locally advanced esophageal cáncer of lower esophagus The biopsy indicated moderately differentiated basaloid cell carcinoma. The clinical diagnosis was cT4NxM0, We decided multimodal treatment with curative intent: Neoadjuvant chemoradiotherapie at a dose of 41.4 Gy and concomitant carboplatin and pacliotaxel 5 cycles (CROSS scheme) plus surgery. Results PET-TAC post-neoadjuvant re-evaluation showed partial morphological response (reduction of tumor metabolism in 34.7%). 6 weeks after radiochemotherapy we performed a three fields total esophagectomy. Postoperative course without incidents. The pathological diagnosis was BASALOID cell CARCINOMA located in distal esophagus of 10 cm long with 30% tumor residual; it affects gastro-oesophageal junction. Stage TNM 7th ed: ypT3 N0 (0/17) L0V1R0 Our patient is fine and without evidence of recurrence after 15 meses. Conclusion Basal squamous cell carcinoma is more common in men around 60 years old, being rare in older women. They are located more frequently in the middle than in lower esophagus. They are tumors of poor prognosis (poorly differentiated, locally advanced and with an aggressive biological behavior that predisposes to early metastasis) although the latest publications relate the prognosis especially with the stage of the tumor. There are no published data about the use of Neoadjuvant treatment for these tumors. We have carried out a multimodal treatment (Cross scheme) followed by surgery with clinical, radiological (PET-TAC) and pathological response (30% of residual tumor in the piece) CONCLUSION The multimodal treatment with Cross scheme and surgery was useful in patients with Basaloid tumor of the esophagus can be considered for patients with this type of tumor. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Prognosis and Feasibility of Extensive Clinical Target Volume in Postoperative Radiotherapy for Esophageal Squamous Cell Carcinoma: A Phase II Clinical Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaofei Zhang ◽  
Dashan Ai ◽  
Juanqi Wang ◽  
Yun Chen ◽  
Qi Liu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Postoperative Radiotherapy ◽  
Locally Advanced ◽  
Target Volume ◽  
Local Control Rate

BackgroundThis trial aims to explore the feasibility and safety of postoperative radiotherapy covering all regional lymph node areas for locally advanced thoracic esophageal squamous cell carcinoma patients treated with intensity-modulated radiation therapy (IMRT).MethodsThis was a single-center single-arm, phase II clinical trial initiated in 2014. Patients who were treated with radical transthoracic resection and had negative margins within 3 months and histologically confirmed esophageal squamous cell carcinoma (pT3-4 or N+, M0 determined by the 7th edition of the AJCC guidelines) were recruited in this trial. Postoperative radiotherapy was performed with a total dose of 40 Gy in 20 fractions using IMRT. Clinical target volumes (CTVs) included the tumor bed, anastomosis, bilateral supraclavicular region, mediastinal lymph nodes, left gastric lymph nodes and celiac trunk lymph nodes. The primary endpoint was the 2-year local control rate, and the secondary endpoints were overall survival (OS) and adverse events (AEs).ResultsA total of 70 eligible patients were recruited from 2014 to 2016. The 2-year local control rate, as the primary endpoint, was 67.3%. In addition, the median OS was 57.0 months, with 1-year and 3-year OS rates of 92.8% and 60.9%, respectively. Among the patients, 28/40 (40%) developed locoregional recurrence, with 25.7% involving hematogenous recurrences. All reported AEs occurred during the course of IMRT or within 6 months thereafter. None of them suffered grade 4 hematological or nonhematological AEs. Nearly all patients completed the entire course of postoperative radiotherapy, with a completion rate of 97.1%.ConclusionFor an extensive target volume, 40 Gy is feasible and shows acceptable toxicity in patients with locally advanced thoracic esophageal squamous cell carcinoma, although the local recurrence rate is relatively high. Our findings provide a basis for further exploration of high-dose radiation with extensive CTV combined with chemotherapy.Clinical Trial Registration[http://www.clinicaltrials.gov/ct2/results?cond=&term=NCT02384811&cntry=&state=&city=&dist=], identifier [NCT02384811].

Role of chemoradiotherapy alone in the management of unfit patients with nonmetastatic locally advanced squamous cell carcinoma of the esophagus.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 138-138
Author(s):  
A. Pisa ◽  
I. Moya ◽  
C. Pericay ◽  
E. Dotor ◽  
J. Alfaro ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Surgical Procedures ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Squamous Cell Carcinoma ◽  
Carcinoma Of The Esophagus

138 Background: Surgery is considered the best treatment for patients (pts) with non-metastatic locally advanced squamous cell carcinoma of the esophagus who have responded to neoadjuvant chemoradiotherapy (CRT) in terms of locoregional control. However, in these pts PFS and OS have not been proved superior to those achieved by CRT alone. Besides, the addition of surgery to CRT increases treatment-related morbidity and mortality. Unfit pts are usually declined for surgical procedures and included in definitive CRT programs. The aim of this study was to define the role of non-surgical strategies (CRT, CT or RT) in unfit pts considered non-optimal for surgical procedures. Methods: We retrospectively reviewed 90 pts with squamous cell carcinoma of the esophagus who had been diagnosed and treated at our institution from January 2004 to December 2009. Fifty-one pts were non-metastatic among which 19 underwent surgery and 32 a non-surgical procedure (CRT, CT, RT or BSC). Our aim was to identify OS, PFS, RR, data on comorbidity and toxicity in these 32 pts. Results: Thirty out of the 32 pts were men with a median age of 62 years (range 41-90). Comorbidity was detected in 17 pts (53%) as means of respiratory disorders (21.9%), cardiopathy (12.5%), hepatopathy (21.9%), synchronic tumors (25%) and metachronic tumors (25%). Seventeen pts received CRT, 7 received CT, 1 received RT and 7 received BSC alone (53%, 22%, 3% and 22% respectively). Grade 3 and 4 toxicities were observed in 15 pts (46.9%) as means of mucositis (18.8%), oesophagitis (15.6%), diarrhoea (12.5%) and neutropaenia (12.5%). One patient in the CRT group died of toxicity. RR was 43.8% (70.6% for CRT, 14.3% for CT alone). Median follow-up was 17.2 months. Median PFS was 11.3 ± 6.12 months (17.9 for CRT, 5.1 for CT alone). Median OS was 15.6 ± 7.6 months (6.9 for CT alone). Conclusions: Our experience with CRT alone in unfit pts with locally advanced squamous cell carcinoma of the oesophagus supports its use with a median PFS of 17.9 months and controllable toxicity. Data on median OS are lacking due to pending long-term follow-up. No significant financial relationships to disclose.

Definitive Chemoradiotherapy for T4 and/or M1 Lymph Node Squamous Cell Carcinoma of the Esophagus

1999 ◽  
Vol 17 (9) ◽  
pp. 2915-2915 ◽  
Author(s):  
Atsushi Ohtsu ◽  
Narikazu Boku ◽  
Kei Muro ◽  
Keisho Chin ◽  
Manabu Muto ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Dose Intensity ◽  
Complete Response ◽  
Carcinoma Of The Esophagus ◽  
Advanced Carcinoma ◽  
Grade 3

PURPOSE: To investigate the efficacy and feasibility of concurrent chemoradiotherapy for locally advanced carcinoma of the esophagus. PATIENTS AND METHODS: Fifty-four patients with clinically T4 and/or M1 lymph node (LYM) squamous cell carcinoma of the esophagus were enrolled. Patients received protracted infusion of fluorouracil 400 mg/m2/24 hours on days 1 to 5 and 8 to 12, 2-hour infusion of cisplatin 40 mg/m2 on days 1 and 8, and concurrent radiation therapy at a dose of 30 Gy in 15 fractions over 3 weeks. Filgrastim was prophylactically administered to 35 patients. This schedule was repeated twice every 5 weeks, for a total radiation dose of 60 Gy, followed by two courses of fluorouracil (800 mg/m2/24 hours for 5 days) and cisplatin (80 mg/m2 on day 1). RESULTS: There were 21 patients with T4M0 disease, one with T2M1 LYM, 17 with T3M1 LYM, and 15 withT4M1 LYM. Forty-nine patients (91%) completed at least the chemoradiotherapy segment. The 18 patients (33%) who achieved a complete response included nine (25%) of the 36 with T4 disease and nine (50%) of the 18 with non-T4 disease. Major toxicities were leukocytopenia and esophagitis; there were four (7%) treatment-related deaths. Prophylactic filgrastim reduced the incidence of grade 3 or worse leukopenia without improving dose-intensity or response. With a median follow-up duration of 43 months, median survival time was 9 months. The 3-year survival rate was 23%. CONCLUSION: Despite its significant toxicity, this combined modality seemed to have curative potential even in cases of locally advanced carcinoma of the esophagus.

Radio(chemo)therapy for locally advanced squamous cell carcinoma of the esophagus

2014 ◽  
Vol 191 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Arif Deniz Ordu ◽  
Carsten Nieder ◽  
Hans Geinitz ◽  
Philipp Günther Kup ◽  
Lisa Felicia Deymann ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Advanced Squamous Cell Carcinoma ◽  
Carcinoma Of The Esophagus
Sign in / Sign up

Export Citation Format

Share Document