Gastrointestinal Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_7_2070 - Long-Term Follow-Up Results of Concurrent Chemo-Proton Therapy for Esophageal Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Long-Term Follow-Up Results of Concurrent Chemo-Proton Therapy for Esophageal Cancer
H. Ishikawa, T. Nonaka, K. Ohnishi, T. Ohno, N. Mizoguchi, K. Murofushi, T. Iizumi, Y. Sekino, T. Okumura, and H. Sakurai; Department of Radiation Oncology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan

Purpose/Objective(s): Protons are known to have physical advantages in radiation therapy (RT) for deep-seated tumors because of spread-out Bragg peak making a desirable dose distribution for the target volume. Although treatment outcomes of RT for esophageal cancer had been improved using concurrent chemotherapy and 3-dimmensional conformal RT technique, cardio-pulmonary dysfunction as late adverse effects of RT worsen the patients’ quality of life. The purpose of the present study is to retrospectively evaluate update results of concurrent chemo-proton therapy (CCPT) for esophageal cancer.

Materials/Methods: Sixty-seven esophageal cancer patients (men: 57, women: 10) had received proton therapy concurrently combined with chemotherapy (cisplatin, 70mg/m2 day 1, and 5-fluorouracil (5-FU), 700 mg/m2 on days 1-4, every 28 days, 2-4 cycles) between November 2008 and June 2014. Their median age was 70 years (range, 36-83 years), and the tumors were located at cervical, the upper thoracic, middle thoracic, lower thoracic, and abdominal esophagus in 2, 17, 30, 14, and 4 patients, respectively. According to the UICC TNM classification (7th edition), their clinical stage were classified into stage I in 27, II in 16, III in 23, and IV in 1, respectively. Forty-five (67%) patients denied receiving surgery but 22 (33%) patients were inoperable mainly due to their co-existing diseases. A total dose of 60 gray equivalent (GyE) in 30 fractions with a conventional fractionation was delivered, and an additional boost of 2 to 10 GyE was given when residual tumors were suspected by examination under endoscopy at 50 GyE.

Results: The median follow-up time of the study was 49 months (range, 6-105 months). For evaluation of initial treatment responses based on endoscopy and chest CT at 1-2 month after CCPT, tumors regressed completely (n=50) and partially (n=15) but 2 tumors were judged as progressive diseases. Recurrences were observed at esophagus alone in 14 including 3 recurrences outside RT field, at mediastinal lymph node alone in 6, at both of the esophagus and mediastinal lymph node in 1, and at the distant organs in 7 patients. The three-year loco-regional control rate was 73%. Salvage treatments including surgery or endoscopic submucosal dissection were curatively performed for 12 of 21 patients with non-distant recurrences, and 9 patients developed no further recurrence. The 4-year overall survival rates of stage I, II, and III were 96%, 73%, and 40%, respectively (p<0.01). Esophageal stricture and ulcer developed in 1 and 4 patients, respectively, but an additional boost was unrelated with adverse effects at the esophagus. None of grade 3 late cardio-pulmonary toxicity was observed except in one patient who had dialysis because of renal dysfunction observed before CCPT.

Conclusion: Proton therapy would be a promising RT modality to reduce the incidence of cardio-pulmonary toxicity after CCRT for esophageal cancer.

Author Disclosure: H. Ishikawa: None. T. Nonaka: None. K. Ohnishi: None. T. Ohno: None. N. Mizoguchi: None.

Hitoshi Ishikawa, MD, PhD

Presentation(s):

Send Email for Hitoshi Ishikawa


Assets

SU_7_2070 - Long-Term Follow-Up Results of Concurrent Chemo-Proton Therapy for Esophageal Cancer



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for Long-Term Follow-Up Results of Concurrent Chemo-Proton Therapy for Esophageal Cancer