Study of consolidation chemotherapy after definitive chemoradiation in locally advanced carcinoma esophagus in a tertiary care hospital

Authors

DOI:

https://doi.org/10.15587/2519-4798.2023.274476

Keywords:

ca oesophagus, the squamous cell ca, consolidation chemotherapy, CCRT, Pactitaxel, Carboplatin, Esophagitis, Chemo induced neurotoxicity

Abstract

Concurrent chemoradiation (CCRT) is considered the standard of care in locally advanced and inoperable carcinoma oesophagus patients. However, the majority of these patients have residual disease after completion of CCRT, and there are no definitive treatment guidelines for the management of the residual disease. Reports on consolidation chemotherapy for patients with oesophagal cancer after definitive CCRT are rare and have shown mixed results.

The aim of this study was to see the effects of consolidation chemotherapy in patients of CCRT who had residual disease and were not surgical candidates and also monitor its side effects.

Material and methods: It was a prospective interventional protocol over 2 years where patients received 4 cycles of consolidation chemotherapy post-CCRT. These patients were followed after completion of chemotherapy for response, toxicity and survival.

Results: 45 patients were initially enrolled for the study, histopathologically proven carcinoma of the oesophagus, out of which 30 patients finally received the full course of treatment and were available for final assessment. After consolidation chemotherapy, 23 (76.7 %) patients had a complete response, 3 (10 %) had a partial response, and 4 (13.3 %) had stable disease. There was no progression of the disease during treatment. The overall treatment protocol was well tolerated by all the patients. There were no grade IV toxicities. On follow-up till the compilation of this data, 23 (76.6 %) of the patients were alive, and 7 (23.3 %) died (disease-related events). Out of these 7 patients, 4 patients had a local failure, and 3 patients developed distant metastasis in the form of brain and liver metastasis.

Conclusion: Consolidation chemotherapy after concurrent chemoradiation in locally advanced, inoperable carcinoma oesophagus is a well-tolerable protocol with high chances of complete response rates

Author Biographies

Wajahat Ahmad, Government Medical College Srinagar

MBBS, MD. Radiotherapy

Department of Radiation Oncology

Arshad Manzoor Najmi, SKIMS

MBBS, MD. Radiotherapy

Department of Radiation Oncology

Nahida Wani, Government Medical College

MBBS, MD. Radiotherapy

Department of Radiation Oncology

Shaqul Qamar Wani, SKIMS

MBBS, MD. Radiotherapy

Department of Radiation Oncology

Saquib Zaffar Banday, SKIMS

MBBS, MD. Radiotherapy

Department of Medical Oncology

Shahida Nasreen, SKIMS

MBBS, MD. Radiotherapy

Department of Radiation Oncology

References

  1. GLOBOCON (2020). World Health Organization. Available at: https://gco.iarc.fr/today
  2. Pakzad, R., Mohammadian-Hafshejani, A., Khosravi, B., Soltani, S., Pakzad, I., Mohammadian, M. et al. The incidence and mortality of esophageal cancer and their relationship to development in Asia. Annals of Translational Medicine, 4 (2), 29.
  3. Tustumi, F., Kimura, C. M. S., Takeda, F. R., Uema, R. H., Salum, R. A. A., Ribeiro-Junior, U., Cecconello, I. (2016). Prognostic factors and survival analysis in esophageal carcinoma. ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 29 (3), 138–141. doi: https://doi.org/10.1590/0102-6720201600030003
  4. Noronha, V., Simha, V., Patil, V., Joshi, A., Prabhash, K. (2019). Role of palliative chemotherapy and targeted therapy in advanced esophageal and gastroesophageal junction cancers. Cancer Research, Statistics, and Treatment, 2 (2), 172–181. doi: https://doi.org/10.4103/crst.crst_10_19
  5. Zarean, E., Mahmoudi, M., Azimi, T., Amini, P. (2018). Determining Overall Survival and Risk Factors in Esophageal Cancer Using Censored Quantile Regression. Asian Pacific Journal of Cancer Prevention, 19 (11), 3081–3086. doi: https://doi.org/10.31557/apjcp.2018.19.11.3081
  6. Shapiro, J., van Lanschot, J. J. B., Hulshof, M. C. C. M., van Hagen, P., van Berge Henegouwen, M. I., Wijnhoven, B. P. L. et al. (2015). Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. The Lancet Oncology, 16 (9), 1090–1098. doi: https://doi.org/10.1016/s1470-2045(15)00040-6
  7. Ochi, M., Murakami, Y., Nishibuchi, I., Kubo, K., Imano, N., Takeuchi, Y. et al. (2020). Long-term results of definitive chemoradiotherapy for unresectable locally advanced esophageal squamous cell carcinoma. Journal of Radiation Research, 62 (1), 142–148. doi: https://doi.org/10.1093/jrr/rraa110
  8. Wu, S.-X., Li, X.-Y., Xu, H.-Y., Xu, Q.-N., Luo, H.-S., Du, Z.-S. et al. (2017). Effect of consolidation chemotherapy following definitive chemoradiotherapy in patients with esophageal squamous cell cancer. Scientific Reports, 7 (1). doi: https://doi.org/10.1038/s41598-017-17254-9
  9. Zhao, Z., Zhang, Y., Wang, X., Geng, X., Zhu, L., Li, M. (2020). Clinical response to chemoradiotherapy in esophageal carcinoma is associated with survival and benefit of consolidation chemotherapy. Cancer Medicine, 9 (16), 5881–5888. doi: https://doi.org/10.1002/cam4.3273
  10. Society AC. Cancer Facts & Figures (2016). American Cancer society.
  11. Chen, X., Yuan, Z., Lu, M., Zhang, Y., Jin, L., Ye, W. (2016). Poor oral health is associated with an increased risk of esophageal squamous cell carcinoma – a population-based case-control study in China. International Journal of Cancer, 140 (3), 626–635. doi: https://doi.org/10.1002/ijc.30484
  12. Andrici, J., Eslick, G. D. (2015). Hot Food and Beverage Consumption and the Risk of Esophageal Cancer. American Journal of Preventive Medicine, 49 (6), 952–960. doi: https://doi.org/10.1016/j.amepre.2015.07.023
  13. Mathieu, L. N., Kanarek, N. F., Tsai, H.-L., Rudin, C. M., Brock, M. V. (2013). Age and sex differences in the incidence of esophageal adenocarcinoma: results from the Surveillance, Epidemiology, and End Results (SEER) Registry (1973-2008). Diseases of the Esophagus, 27 (8), 757–763. doi: https://doi.org/10.1111/dote.12147
  14. Mchembe, M. D., Rambau, P. F., Chalya, P. L., Jaka, H., Koy, M., Mahalu, W. (2013). Endoscopic and clinicopathological patterns of esophageal cancer in Tanzania: experiences from two tertiary health institutions. World Journal of Surgical Oncology, 11 (1). doi: https://doi.org/10.1186/1477-7819-11-257
  15. Ferndale, L., Sartorius, B., Aldous, C., Thomson, S. (2019). Oesophageal cancer in Area 2 of Kwazulu-Natal: predictors of late presentation. South African Journal of Surgery, 57(2), 3–9. doi: https://doi.org/10.17159/2078-5151/2019/v57n2a2948
  16. Ueda, H., Takeda, M., Ueda, S., Kawakami, H., Okuno, T., Takegawa, N. et al. (2017). Clinical evaluation of palliative chemoradiotherapy for metastatic esophageal cancer. Oncotarget, 8 (46), 80286–80294. doi: https://doi.org/10.18632/oncotarget.17925
  17. Wu, S.-X., Li, X.-Y., Xu, H.-Y., Xu, Q.-N., Luo, H.-S., Du, Z.-S. et al. (2017). Effect of consolidation chemotherapy following definitive chemoradiotherapy in patients with esophageal squamous cell cancer. Scientific Reports, 7 (1). doi: https://doi.org/10.1038/s41598-017-17254-9
  18. Xia, Y., Li, Y., Chen, Y., Liu, Q., Zhang, J., Deng, J. et al. (2018). A phase II trial of concurrent chemoradiotherapy with weekly paclitaxel and carboplatin in advanced oesophageal carcinoma. International Journal of Clinical Oncology, 23 (3), 458–465. doi: https://doi.org/10.1007/s10147-018-1240-4
  19. Ai, D., Zhu, H., Ren, W., Chen, Y., Liu, Q., Deng, J., Ye, J. (2017). Patterns of distant organ metastases in esophageal cancer: a population-based study. Journal of Thoracic Disease, 9 (9), 3023–3030. doi: https://doi.org/10.21037/jtd.2017.08.72

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Published

2023-01-31

How to Cite

Ahmad, W., Najmi, A. M., Wani, N., Wani, S. Q., Banday, S. Z., & Nasreen, S. (2023). Study of consolidation chemotherapy after definitive chemoradiation in locally advanced carcinoma esophagus in a tertiary care hospital. ScienceRise: Medical Science, (1(52), 25–32. https://doi.org/10.15587/2519-4798.2023.274476

Issue

No. 1(52) (2023)

Section

Medical Science

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Copyright (c) 2023 Wajahat Ahmad, Arshad Manzoor Najmi, Nahida Wani, Shaqul Qamar Wani, Saquib Zaffar Banday, Shahida Nasreen

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