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Objective To determine the treatment outcome of nimotuzumab in combination with neoadjuvant concurrent chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC).Methods A total of 23 ESCC patients were enrolled.The preoperative strategies consisted of nimotuzumab (200 mg per week in week 1-5),concurrent chemotherapy by paclitaxel (45 mg/m2 per week in week 2-5) and cisplatin (20 mg/m2 per week in week 2-5) and radiotherapy by a total dose of 40 Gy (2.0 Gy/d,5 days per week in week 2-5).Esophagectomy was performed 4 weeks after the completion of preoperative therapies.Results All of the 23 patients enrolled completed the planned combined therapy method,and 22 patients underwent final surgery.The clinical response rate of nimotuzumab in combination with preoperative chemoradiotherapy was 96％.The most frequent Grade 1/2 toxicities observed were gastrointestinal reaction,bone marrow suppression,and esophagitis.The rate of radical resection was 100％,and the pathological complete response rate was 41％.The incidence rate of postoperative pulmonary infection,anastomotic leak,hoarseness,and arrhythmia were 14％,9％,4％,and 4％,respectively.No perioperative deaths occurred in our study.The 1-,3-,and 5-year overall survival (OS) rate for all the patients were 86％,52％ and 52％,respectively.The median survival time (MST) was 28.9 months.Postoperative pathologic results showed 15 patients with lymph node negative and 7 patients with lymph node positive.the 1-,3-,and 5-year OS for pN0 group were 100％,62％ and 62％,versus 57％,29％ and 29％ for pN+ group (P=0.033).The MST for pNo group was 42.6 months versus 14.2 months for pN + group.Conclusions The regimen of nimotuzumab in combination with preoperative concurrent chemoradiotherapy followed by surgery is safe and effective for locally advanced ESCC.Patients with lymph node negative after surgery have significantly improved long-term survival.
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Objective To analyze the effects of gross tumor volume(GTV-T)and positive lymph node volume(GTV-LN)on the prognosis of radical concurrent chemoradiotherapy for esophageal squamous cell carcinoma(ESCC). Methods A total of 79 patients with stage N1ESCC undergoing radical radiotherapy in our hospital from 2012 to 2015 were enrolled as subjects. GTV-T and GTV-LN were calculated by the Pinnacle39.0 treatment planning system. The receiver operating characteristic(ROC)curves were used to evaluate the value of the GTV-LN/GTV-T ratio in the prediction of local recurrence(LR)and distant metastasis(DM)of ESCC. Results The median follow-up time was 17.2 months in all patients. The ROC curves were made using the GTV-LN/GTV-T ratio. The optimal cut-off values of GTV-LN/GTV-T ratio for predicting the risk of LR and DM were 0.34 and 0.59, respectively. The statistical analysis revealed that the LR rates were 50% and 8% in patients with GTV-LN/GTV-T ratios of<0.34 and ≥0.34, respectively(P<0.01), while the DM rates were 11% and 43% in patients with GTV-LN/GTV-T ratios of<0.59 and ≥0.59, respectively(P= 0.003). Conclusions The GTV-LN/GTV-T ratio may be a predictor of LR and DM in patients with ESCC. Further studies on the GTV-LN/GTV-T ratio may help to make personalized chemoradiotherapy strategies for patients with ESCC.
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Objective To examine the clinical characteristics,treatment,and prognosis of patients with synchronous head and neck and esophageal cancer (SHNEC).Methods The clinical data of 30 SHNEC patients treated in the Department of Radiotherapy of the First Affiliated Hospital of China Medical University from 2010 to 2014 were retrospectively reviewed.The patients were followed up and survival was calculated using the Kaplan-Meier method.Differences between survival curves were analyzed by the log-rank test,and prognostic analysis was performed using the Cox regression model.At the same and different time,the comprehensive diagnosis were 24 cases and 6 cases.21 patients were treated with radiochemotherapy, 9 patients were treated by surgery and radiotherapy±chemotherapy.Results SHNEC was frequently found in elderly men with heavy drinking and smoking habits.Hypopharyngeal cancer with middle esophageal cancer was most common among the patients;of the 30 patients,23(77%) had hypopharyngeal cancer,and 12(40%) had hypopharyngeal cancer with middle esophageal cancer.The median survival time of the patients was 20 months,and the 1-and 2-year overall survival (OS) rates were 83% and 37%,respectively.Univariate analysis showed that the stage of esophageal cancer,heavy smoking and drinking habits,and a family history of cancer were significantly associated with patient prognosis (P=0.009,0.044,0.012).In addition,the Cox analysis also demonstrated that the stage of esophageal cancer (HR=3.53,P=0.008),heavy smoking and drinking habits (HR=2.33,P=0.049),and a family history of cancer (HR=2.78,P=0.026) were independent prognostic factors.Conclusions Hypopharyngeal and middle esophageal cancer is the most common type of SHNEC,and the stage of esophageal cancer and heavy smoking and drinking habits are significantly associated with the prognosis of SHNEC patients.In addition,patients with stage Ⅰ and Ⅱ esophageal cancer can also achieve acceptable survival after receiving radiotherapy-based comprehensive treatment.
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Objective To evaluated the efficacy of biomarker?guided concurrent chemoradiotherapy in unrescetable esophageal squamous cell carcinoma patients. Methods 54 cases of unrescetable esophageal squamous cell carcinoma were enrolled in the prospective non?randomized clinical study and divided into study group and control group. All cases were treated with concurrent chemoraditherapy. Intensity?modulated radiation therapy was used with a dose of 60?66 Gy. Chemotherapy was perfromed on day 1 and d29. In the study group the selection of the chemotherapy drug was based on the excision repair cross?complementation 1 ( ERCC1) ,thymidylate synthetase ( TYMS) ,ribonucleotide reductase M1( RRM1) ,and theβ?tubulin isotypeⅢ( TUBB3) mRNA expression levels. In the control group,the regiment for chemotherapy was Cisplatin plus Fluorouracil. The objective response rate and overall survival ( OS ) were calculated using Kaplan?meier method and log?rank test was used for between?group comparison. The survival rate was calculated using Kaplan?Meier method and analyzed using log?rank method, other comparison was performed by χ2 test. Results The follow?up rate was 100% in the study group and 96% in the controll group. The objective response rate of the study group and the control group were 85% and 86 ( P=0. 483 ) , respectively. The median survival time ( MST) in the study group was 35. 5 months and that in the control group was 25. 8 months. The 1?,2?,and 3?year OS rates of the study group and the control group were 84%,68%,46% and 71%,59%,28% respectively (P=0. 047).No significant differences were observed in the incidence of side?effects in the two groups. Conclusions Selecting the chemotherapy drug according to biomarker,combined with radiation therapy,could improve survival.in unrescetable esophageal squamous cell carcinoma. The value needs further investigation.
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Currently,resectable esophageal cancer is commonly initially treated with surgery in China,but the optimal postoperative treatment remains unclear.Postoperative concurrent chemoradiotherapy can improve local control and reduce distant metastasis and may become the preferred treatment for patients after surgery for esophageal cancer.By summarizing the studies on concurrent chemoradiotherapy after surgery for esophageal cancer,this review points out that postoperative concurrent chemoradiotherapy can improve the overall survival of patients with positive lymph nodes and has tolerable adverse effects,but the populations who can benefit from this treatment,the optimal radiotherapy dosage,target volume,and chemotherapy regimen of postoperative concurrent chemoradiotherapy await further investigation.
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Objective To observe the acute side effects, local control rate and survival rate of concurrent chemoradiotherapy (CC) and radiotherapy alone (R) for patients with esophageal carcinoma.Methods From June 2006 to February 2009, 209 patients with esophageal carcinoma were observed, 105 of them were treated with CC.Of all the patients, 117 received three-dimensional conformal radiotherapy, 92 received intensity modulated radiotherapy, the median prescription dose was 60 Gy.The regimen of LFP (5-FU, cisplatin and calcium folinate) was selected for this study, side effects, local control rate and survival rate were observed and subsets analysis were performed.Results The overall follow-up rate was 99.0%,there were 99 and 44 patients whose follow-up time was more than 2 and 3 years, respectively;for the CC group, the data were 45 and 14, respectively;and for the R group, 54 and 30, respectively.The 1-,2-,3-year local control rates of CC group and R group were 88.1%,69.2%,66.2% and 81.0%,64.0%,54.9%(χ2=2.31,P=0.128), respectively.The 1-,2-,3-year overall survival rates of CC group and R group were 84.4%,52.9%,45.6% and 75.2%,50.7%,37.0%(χ2=1.57,P=0.210),respectively.Subset analysis indicated that for the patients of N0 group and whose length of GTV>7 cm, the local control rate of CC was significantly higher than that of radiotherapy alone (χ2=5.11,7.66;P=0.024, 0.006).For N0 group, the survival rate of CC was higher than that of R alone.(χ2=5.07,P=0.024).The incidence of WBC, PLT and HGB reduction for the two groups were 81.9% and 49.0%(χ2=36.45,P=0.000),14.3% and 1.9%(χ2=10.54,P=0.006),and 24.8% and 2.9%(χ2=22.95,P=0.000),respectively.The incidence of nausea, vomiting and constipation for the two groups were 63.8% and 7.7%(χ2=71.52,P=0.000), respectively.The incidence of ≥2 grade esophagitis of CC group and R group were 48.57% and 38.46%(χ2=2.17,P=0.141), respectively.The incidence of ≥2 grade radiation pneumonitis of CC group and R group were 15.24% and 7.69%(8/104)(χ2=2.93,P=0.087),respectively.ConclusionsCompared to radiotherapy alone, the local control rate and overall survival rate of concurrent chemoradiotherapy were not improved significantly, the patients with N0 may be the conspicuous beneficiary.About side effects, only marrow depression and gastrointestinal tract reaction were significantly different between the two groups,the value of addition of concurrent chemoradiotherapy for esophageal carcinoma needs further investigation.
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Objective To retrospectively analyze the treatment results and side effects of postoperative chemoradiotherapy and postoperative radiotherapy of thoracic esophageal squamous cell carcinoma (EPC) with positive lymph nodes.Methods Three hundred and four patients of thoracic EPC were initially treated with three-field lymphadenectomy, with pathological positive lymph nodes and without distant metastases;and randomly divided into two groups:140 patients of the simple postoperative radiotherapy (RT) and 164 patients of postoperative chemoradiotherapy (CRT).The median total dose was 50 Gy.The regimen of concurrent chemotherapy included cisplatin and taxol, and the intermission was 21 days;the median cycles were 2.35.Results The 3-year overall survival rates were 65.7% of CRT and 52.8% of RT (χ2=6.90,P=0.009), and The 3-year disease-free survival rates were 62.5% of CRT and 52.8% of RT (χ2=4.75,P=0.029).The incidences of the supraclavicular lymph-node metastases were 1.8% and 7.1%(χ2=5.21,P=0.022), respectively;and the incidences of distant metastases were 18.3% and 27.9%(χ2=3.94,P=0.047), respectively;and the incidences of overall metastases and recurrences were 27.4% and 39.3%(χ2=4.80,P=0.028), respectively.Early side effects included granulopenia (96.3% and 32.1%,χ2=140.31,P=0.000), radiation-induced esophagitis (37.2% and 26.4%,χ2=4.01,P=0.045),and gastrointestinal toxicity (23.2% and 5.0%,χ2=19.77,P=0.000).Late side effects were 6.1% and 5.0%(χ2=0.17,P=0.678), respectively.Conclusions Postoperative chemoradiotherapy of thoracic EPC with positive lymph nodes can improve the overall survival and disease-free survival, decrease the incidence of the supraclavicular metastases, the distant metastases, the total metastases and recurrences.More severe early side effects were observed in chemoradiotherapy than in the radiotherapy group,but well tolerated.