Gastrointestinal Cancer

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SU_6_2062 - Concurrent Chemoradiotherapy (CCRT) for Stage I-II Esophageal Cancer Patients

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

Concurrent Chemoradiotherapy (CCRT) for Stage I-II Esophageal Cancer Patients
J. Fukada1, A. Kumabe1, R. Kota1, N. Koike1, H. Toyama1, Y. Shiraishi1, Y. Kitagawa2, and N. Shigematsu1; 1Department of Radiology, Keio University School of Medicine, Tokyo, Japan, 2Surgery, Keio University School of Medicine, Tokyo, Japan

Purpose/Objective(s): CCRT has been adapted for advanced esophageal cancer patients. Meanwhile, we have less opportunities to manage earlier diseases. The aim of the study is to evaluate the efficacy and toxicity of CCRT for stage I-II disease.

Materials/Methods: We reviewed 163 consecutive esophageal cancer patients received 5-FU and CDDP based chemo-radiotherapy between 2000 and 2014. There were 17 women and 146 men and the median age was 67 (range, 46-86 years). Staging was as follows; 92 patients with stage I, 71 patients with stage II ―39 IIa and 32 IIb. Radiotherapy was performed by 6/10MV x-ray and the total dose was from 50 to 60Gy with conventional fractionation. Radiotherapy was delivered to the primary lesion with margin for stage I disease. Elective nodes were included for stage II patients. We adapted concomitant continuous low-dose chemotherapy (LDFP) during 2000 to 2008 (n=76). Protracted infusion of 5-FU 200mg/m2 and CDDP 4mg/m2 were administered on the same day of irradiation. In other patients (n=87) received standard-dose chemotherapy (SDFP), consisted of two cycles of CDDP (70 mg/m2, days 1 and 29) and 5-FU (700 mg/m2, days 1-4 and 29-32). Overall survival rate (OS) and progression-free survival rate (PFS) were calculated according to Kaplan-Meier method, and applied log-rank test to evaluate statistic significance.

Results: The median follow up for surviving patients was 62 (ranged 31 to 194) months. 151 patients completed scheduled irradiation. Actuarial OS at 5 years were 74% for all patients, 80% for stage I, 61% for stage II patients, respectively (p<0.05). PFS at 5 years were 53% for all patients, 62% for stage I, 39% for stage II patients, respectively (p<0.005). According to the initial response, 85% (n=138) achieved complete response (CR), 94% for stage I and 76% for stage II patients. Among them, 49 patients (36%) showed local failure or distant metastasis after initial CR. Salvage endoscopic resection, surgery, chemotherapy or radiotherapy was performed in 14, 11, 15 and 7 patients, respectively. As for the treatment regimen, the 5-year OS was 80% for stage I in both SDFP and LDFP. Regarding stage II, the 5-year OS of 73% in SDFP was higher than that of 51% in LDFP regimen (p=0.18). Major acute adverse events ≥ grade 3 were leukopenia (n= 23, 14%), anorexia (n=14), esophagitis (n=9) and radiation pneumonitis (n=8). As for the late adverse events, pericardial effusion (n=10), pleural effusion (n=3) and esophageal stenosis (n=2) were observed respectively. We lost six patients by cardiac event treated with LDFP regimen.

Conclusion: CCRT for stage I-II esophageal cancer showed favorable outcome with tolerable toxicities. The response rate was high, whereas appropriate salvage therapy was essential for considerable number of recurrent patients. OS was higher in SDFP than LDFP regimen for stage II. It might be suggested the survival rate was influenced by cardiac toxicity.

Author Disclosure: J. Fukada: None. R. Kota: None. N. Koike: None. Y. Shiraishi: None. Y. Kitagawa: None. N. Shigematsu: President; JASTRO.

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