Abstract
Platinum-based chemotherapy is considered a standard treatment option for patients with metastatic esophageal carcinoma. However, the overall survival of patients receiving such treatment is <1 year. A common presenting symptom of esophageal cancer is dysphagia, which has a substantial impact on quality of life. We have now retrospectively evaluated the efficacy and safety of palliative chemoradiotherapy for patients with stage IV esophageal cancer, most of whom are unfit for curative chemoradiotherapy. Fifty consecutive patients diagnosed with stage IV esophageal cancer were treated with concurrent chemoradiotherapy at Kindai University Hospital between April 2008 and December 2014. Most (90%) patients received a total radiation dose of at least 50 Gy, and the median number of treatment cycles per patient was four for the combination of 5-fluorouracil and cisplatin. The response of the primary tumor and the overall response were 80% and 44%, respectively. The dysphagia score was improved after chemoradiotherapy in 36 (72%) patients and did not change between before and after treatment in 14 (28%) patients. With a median follow-up time of 9.4 months from the start of chemoradiotherapy, the median progression-free survival and overall survival were 4.7 and 12.3 months, respectively. Three patients (T4b in two, T3 in one) developed esophagobronchial fistula after completion of chemoradiotherapy (n = 2) or after disease progression (n = 1), resulting in death in each case. Our results suggest that palliative chemoradioiotherapy was safe and contributed the improvement of dysphagia in patients with stage IV esophageal cancer.
Highlights
Esophageal cancer is the eighth most frequently diagnosed cancer worldwide, and, despite improvements in surgical technique and the development of new approaches to treatment, it remains one of the most difficult malignancies to cure
Between April 2008 and December 2014, 123 consecutive patients were diagnosed with stage IV esophageal cancer according to the seventh edition of the Tumor-Node-Metastasis (TNM) classification system developed by the International Union Against
Seventy-three of these 123 patients were excluded from the study because they received chemotherapy (n = 30) or radiotherapy (n = 8) alone, they received definitive chemoradiotherapy in which supraclavicular or abdominal lymph nodes (M1 lymph nodes) were covered by the extended field of radiotherapy (n = 13), they received supportive care (n = 21), or they were transferred to another hospital (n = 1)
Summary
Esophageal cancer is the eighth most frequently diagnosed cancer worldwide, and, despite improvements in surgical technique and the development of new approaches to treatment, it remains one of the most difficult malignancies to cure. About 50% of individuals with esophageal cancer already have metastatic disease at diagnosis and are candidates for palliative therapy [1]. Many patients who present with symptoms of esophageal obstruction already have locally advanced or metastatic disease. Intubation with self-expanding metal stents, and brachytherapy are effective palliative treatments to ameliorate dysphagia in patients with advanced esophageal cancer, the median survival of individuals receiving such noninvasive therapy is only ~6 months [6, 7]. Given that chemoradiotherapy with the combination of cisplatin and 5-FU is a standard therapy for patients with inoperable, locally advanced esophageal cancer and has a tolerable toxicity profile [10], the aim of the present study was to clarify the efficacy and safety of palliative concurrent chemoradiotherapy for patients with stage IV esophageal cancer who are unfit for curative chemoradiotherapy
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