Chemoradiation Therapy For Esophageal Carcinoma Research Articles

Predictive factors of esophageal stricture after definitive chemoradiation therapy for esophageal carcinoma: A retrospective single institute study

Predictive factors of esophageal stricture after definitive chemoradiation therapy for esophageal carcinoma: A retrospective single institute study

Nutrition Status and Inflammatory Indexes Could Predict Acute Toxicity After Concurrent Chemoradiation Therapy for Esophageal Carcinoma

To evaluate the influence on acute toxicity with different nutrition status and inflammatory indexes ofthe patients after concurrent chemoradiotherapy in esophageal carcinoma. A total of 338 cases of esophageal carcinoma who underwent intensity modulated radiation therapy (IMRT)with concurrent chemotherapy were eligible for retrospectively analysis. The influence on acute toxicity with different nutrition status such as body mass index level (BMI), albumin level (ALB), total lymphocyte count level (TLC), anemia and inflammatory indexes including neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) were observed after the treatment. The incidence rate of malnutrition according to different nutrition status was ranging from 5.62% to 54.14%. The incidence of acute radiation esophagitis of grade 2 and above in low ALB group were higher than that in normal ALB group (χ2=75.677，P=0.000). The incidence of hematologic toxicity among different TLC levels had statistical difference significantly. With the decline of TLC level, the incidence of hematologic system toxicity was increased (χ2=12.891，P=0.006), but the rate of acute radiation pneumonitis was decreased (χ2=19.775，P=0.001). The incidences of acute radiation esophagitis of grade 2 and above in anemia group were much higher than that in normal group (χ2=37.774, P=0.000). An higher incidence of acute radiation esophagitis was shown in NLR and PLR high level groups than in lower NLR and PLR groups (χ2=64.207, P=0.000; χ2=11.260, P=0.004). Accompanied by NLR and PLR levels elevate,the rate of acute radiation esophagitis is ascendant, where as the rate is decendant with ALB and Hb levels decline. The occurrence of hematologic system toxicity will increases and acute radiation pneumonitis decreases when TLC levels goes down.

The Important Prognostic Value of Pretreatment Stage in Patients Achieving Pathologic Complete Response After Neoadjuvant Therapy of Esophageal Cancer

Purpose/Objective(s): Previous studies have depicted a correlation between 18FDG PET maximum standardized uptake value (SUVmax) and pathologic complete response (pCR) in patients treated with preoperative chemoradiation therapy (CRT) for esophageal cancer. However, it is unclear whether or not this correlation differs based on tumor histology. Our objective is to determine how SUVmax before and after neoadjuvant CRT for esophageal carcinoma relates to the rate of pCR at surgical resection, and to examine whether or not the relationship varies based on histology. Materials/Methods: After IRB approval, patients at two NCI-designated cancer centers from 2000-2013 who were treated with neoadjuvant CRT followed by surgical resection for esophageal cancer were identified. Medical records were reviewed to gather clinical, radiographic, and pathologic data. PET scans were performed prior to and 3-6 weeks after the completion of preoperative CRT. SUVmax was measured at each scan, and the percent decrease in SUVmax was calculated. A least squares regression analysis was performed to investigate an association between pCR and important clinical factors. Results: One hundred and thirty-two patients were identified. Median age was 62 (36-80), 79% male and 21% female. Adenocarcinoma was identified in 83% and squamous cell carcinoma in 16%; one patient had a neuroendocrine tumor. One hundred and four (79%) patients had a PET scan both prior to and after the completion of preoperative CRT. Thirty percent of patients achieved a pCR, 20% had residual microscopic disease, and 50% had gross residual disease. The pCR rates for adenocarcinoma and squamous cell carcinoma were 28% and 36% respectively. The percent decrease in SUVmax was significantly associated with pCR (p Z 0.04). The median preand post-treatment SUVmax were 9.5 (2.3 44.4) and 4.1 (0 24.4) respectively, and did not differ significantly based on histology. The mean reduction in SUVmax was 60%. For patients achieving a pCR, the mean reduction was 69% compared to 56% for patients with residual disease. When controlling for histology, SUVmax remained associated with pCR (p Z 0.04). The median post-treatment SUVmax was 4.1. Patients who had a post-treatment SUV of 4.1 or less were more likely to have a pCR (p Z 0.02). Conclusions: In this cohort of patients, we confirm that SUV response after neoadjuvant CRT is significantly associated with pCR. Additionally, this association holds true when controlling for histologic type. These data should be considered as new approaches are modeled based on responseadapted therapy. Author Disclosure: M. Zaki: None. T. Shaikh: None. M. Dominello: None. E.J. McSpadden: None. M. Yu: None. S. Cohen: None. W. Scott: None. A. Shields: None. P. Philip: None. M. Choi: None. J.E. Meyer: None. A.A. Konski: None.

Women at increased risk for cardiac toxicity following chemoradiation therapy for esophageal carcinoma

PurposeThe purpose of this study was to identify factors associated with cardiac toxicity in patients treated with chemoradiation therapy (CRT) for esophageal carcinoma. Methods and MaterialsOne hundred twenty-seven patients with adenocarcinoma or squamous cell carcinoma of the esophagus treated from July 2002 to June 2011 at 2 academic institutions with preoperative or definitive CRT were retrospectively reviewed. Association of cardiac toxicity with a number of variables was investigated, including heart disease, cardiac bypass and angioplasty, diabetes, insulin use, smoking, chemotherapy regimen, and tumor location. T test assessed risk of cardiac toxicity secondary to age. Dose volume histograms (DVH) were evaluated for percentage of heart volume receiving >20, 30, 40, and 50 Gy (V20-V50). The Fisher exact test analyzed for an association between dose volume parameters and cardiac toxicity. ResultsPatient population included 100 men and 27 women with a mean age of 64 years. Median follow-up was 12.7 months (range, 0.3-99.6 months). Any cardiac toxicity occurred in 28 patients, the majority of which were pericardial effusion (23/28). Odds ratio for toxicity in women was 4.15 (95% confidence interval [CI], 1.63-10.50; P = .0017) and time to cardiac toxicity by sex was significant (P = .0003). Patients above the median cutoff for V20, V30, and V40 had increased odds of developing cardiac toxicity (P = .03, .008, .002). There was 4.0 increased odds of developing cardiac toxicity with V40 >57% (95% CI, 1.5-10.3, P = .002). On multivariable logistic regression analysis, sex was the only variable associated with any cardiac toxicity and pericardial effusion (P = .0016, P = .0038). None of the other investigated variables were associated with increased risk of cardiac toxicity. ConclusionsFemale patients and dose greater than the median for V20-V40 were associated with the development of cardiac toxicity, specifically pericardial effusion. These data suggest exercising increased care when designing radiation fields in women undergoing CRT for esophageal carcinoma, as pericardial effusion may be a long-term complication.

A prospective trial of self-expanding metal stents in the palliation of malignant esophageal obstruction after failure of primary curative therapy

Background: Self-expanding metal stents have been shown to be safe and effective for the primary palliation of patients with inoperable malignant esophageal obstruction. We sought to determine their safety and efficacy in patients who fail curative therapy. Methods: Seventeen patients with esophageal carcinoma who had recurrent dysphagia after radiation, surgery, or chemoradiation therapy for esophageal carcinoma were studied. All patients had recurrent dysphagia, and an uncovered metal stent was inserted for palliation. Patients were followed-up at 4-week intervals until death. Palliation was measured by a dysphagia score and the Karnofsky index. Results: Seventeen patients with recurrent dysphagia after primary treatment with surgery (n = 4), radiation (n = 11), and chemoradiation (n = 2) received uncovered Wallstents for palliation of dysphagia. The dysphagia score improved by at least 1 point in all patients. Thirteen of 17 patients had a 2 point improvement in the dysphagia score. The Karnofsky index improved significantly (from 58 ± 3 to 66 ± 3, p = 0.0002). Fourteen of the 17 patients had patent stents until death. Three of 12 patients (25%) died of stent-related complications (bleeding in 1, septic complications in 2 patients). Conclusions: Patients with recurrence of esophageal carcinoma after surgery can be successfully treated with metal stents, but patients who have received radiation therapy with curative intent may be at greater risk for complications because of radiation-induced tumor necrosis and vascular changes in the esophageal wall. Larger prospective studies are necessary to clarify this issue. (Gastrointest Endosc 1996;44:283-6.)