Abstract
BackgroundStandard chemoradiotherapy (CRT) using cisplatin (CDDP) and 5-fluorouracil (5-FU) is an optional treatment for patients with stage II-III esophageal cancer. However, there are some demerits in this regimen because CDDP administration requires a large transfusion volume and 5-FU must be continuously infused over 24 h. Therefore, hospitalization is unavoidable. We collected retrospectively the data of definitive CRT with nedaplatin and S-1 as carried out in our institution.MethodsPatients with early and advanced esophageal cancer and relapsed esophageal cancer after radical surgery were included. Nedaplatin 80 mg/m2 was given on days 1 and 29, and S-1 80 mg/m2 on days 1-14 and 29-42. No prophylactic treatment with granulocyte colony stimulating factor was administered. Patients received two courses of concurrent radiotherapy of more than 50 Gy with or without two additional courses as adjuvant therapy every 4 weeks.ResultsBetween August 2011 and June 2015, 89 patients (age range, 44–86 years; K-PS 90–100, 81 %; squamous cell carcinoma histology, 97 %; definitive/salvage CRT, 75/25 %) were collected. Twenty-one (24 %) patients completed four cycles, and 94 % received two or more cycles. Grade 4 leukopenia, thrombocytopenia, and anemia occurred in 12, 7, and 10 % of the patients, respectively. Five patients developed febrile neutropenia. Grade 3 non-hematological toxicity included infection in 12 %, mucositis/esophagitis in 3 %, kidney in 3 %, and fatigue in 3 %. Sixty-four patients (72 %) received the prescribed full dose and full cycles of chemotherapy. A complete response was achieved in 76 patients (85 %). The 3-year overall survival rate was 54.4 % in definitive CRT and 39.8 % in salvage CRT, respectively. Sixty-two subjects (70 %) received treatment as outpatients.ConclusionsNedaplatin and S-1 in combination with radiotherapy is feasible, and toxicity is tolerable. This treatment method has the potential to shorten hospitalization without impairing the efficacy of CRT.
Highlights
Concurrent chemoradiotherapy (CRT) is well established as a standard approach to treat esophageal cancer.Cis-diammine-glycolatoplatinum is a platinum derivative that was developed with the aim of reducing renal toxicity while maintaining the effectiveness of CDDP [1]
In an in vivo study, a combination of nedaplatin (NDP) and 5-FU has been shown to be as effective as a combination of CDDP and 5-FU [2]
S-1 is frequently used as a substitute for 5-FU in gastric cancer, but limited data are available for esophageal cancer [8]
Summary
Concurrent chemoradiotherapy (CRT) is well established as a standard approach to treat esophageal cancer.Cis-diammine-glycolatoplatinum (nedaplatin) is a platinum derivative that was developed with the aim of reducing renal toxicity while maintaining the effectiveness of CDDP [1]. Concurrent chemoradiotherapy (CRT) is well established as a standard approach to treat esophageal cancer. In an in vivo study, a combination of nedaplatin (NDP) and 5-FU has been shown to be as effective as a combination of CDDP and 5-FU [2]. Combination chemotherapy using NDP and 5-FU has been reported to be a safe and effective method for treating advanced esophageal cancer [3, 4]. The advantages of S-1 compared with 5-FU are greater convenience because of its oral formulation and continuous delivery, without intravenous infusion. Combination chemotherapy with S-1 and cisplatin has been widely studied in advanced gastric cancer [9,10,11]. Standard chemoradiotherapy (CRT) using cisplatin (CDDP) and 5-fluorouracil (5-FU) is an optional treatment for patients with stage II-III esophageal cancer. We collected retrospectively the data of definitive CRT with nedaplatin and S-1 as carried out in our institution
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