Palliative Care

PV QA 3 - Poster Viewing Q&A 3

TU_32_3050 - The Safety and Efficacy of SBRT for locoregional recurrences after prior chemoradiation for advanced esophageal carcinoma

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

The Safety and Efficacy of SBRT for locoregional recurrences after prior chemoradiation for advanced esophageal carcinoma
S. N. Seyedin1, M. K. Gannon2, K. A. Plichta1, and B. G. Allen1; 1Department of Radiation Oncology, University of Iowa Hospitals & Clinics, Iowa City, IA, 2University of Iowa, Carver College of Medicine, Iowa City, IA

Purpose/Objective(s): Approximately 20% of patients who receive radiation and chemotherapy for esophageal cancer develop locoregional recurrence after surgical resection. While stereotactic body radiation therapy (SBRT) has been investigated as a salvage therapy for various sites, its role in recurrent esophageal cancer is unknown. We hypothesized that SBRT would provide durable local control with minimal associated toxicity.

Materials/Methods: This IRB approved institutional retrospective study examined patients who received SBRT for locoregional failure after initial chemoradiation for non-metastatic advanced esophageal cancer. SBRT was given in 5 fractions every other day. Tumor sizes in longest dimension at the time of SBRT were recorded along with initial tumor staging at the time of diagnosis. Gastrointestinal and constitutional toxicities from SBRT during and after treatment were scored using the Common Terminology Criteria for Adverse Events (version 4.03). CT and MRI were used for radiographic surveillance after SBRT. If disease progression occurred following SBRT, the location of relapse relative to SBRT treatment fields were recorded. Progression free survival (PFS) and overall survival (OS) were calculated from the date of completion of SBRT to the date of progression and death or last visit with an oncologist.

Results: At the time of analysis, 9 patients with 11 locoregional recurrences treated with SBRT were eligible for this study with a median follow-up of 6.8 months. The median age of patients was 63. Most patients initially presented with T3 (88.9%), N1 (55.6%), moderately differentiated (66.7%) adenocarcinoma (88.9%) and received 50.4 Gy in 28 fractions with concurrent carboplatin/paclitaxel chemotherapy. Two patients did not undergo surgical resection following neoadjuvant chemoradiation. Median time to recurrence was 17.7 months (range 4.2 – 59.5) occurring in the mediastinum (7), gastrohepatic lymph node (1), esophagectomy anastomotic site (1), celiac axis (1), and left supraclavicular node (1). SBRT median total dose was 27.5 Gy (22.5 – 30 Gy). The median tumor size was 2.5 cm (range 1.4-4.6). Two patients experienced grade 1 fatigue during and after SBRT but none endorsed any dysphagia, esophagitis, nausea or vomiting. None of the patients on this study experienced grade 3 or greater toxicity. There was no evidence of chronic toxicity associated with SBRT. One subject experienced a SBRT failure at 2.8 months while 4 patients developed distant failure at 2.0, 3.1, 3.4, and 3.9 months after SBRT treatment. The median PFS was 3.9 months while median OS had not been reached with only 2 patients deceased.

Conclusion: This study demonstrates the feasibility of SBRT for locoregional recurrence for esophageal cancer with minimal toxicity and high rates of local control. Additional prospective clinical studies are required to validate these findings before its integration into practice.

Author Disclosure: S.N. Seyedin: None. M.K. Gannon: None. K.A. Plichta: Employee; Iowa City VA, University of Iowa Hospitals and Clinics. Stock; Rosetta Genomics, Tekmira. B.G. Allen: None.

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