Clinical evaluation of palliative chemoradiotherapy for metastatic esophageal cancer
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Hiroto Ueda1,*, Masayuki Takeda1,*, Shinya Ueda1, Hisato Kawakami1, Tatsuya Okuno1, Naoki Takegawa1, Hidetoshi Hayashi1, Junji Tsurutani1, Takao Tamura1, Kazuki Ishikawa2, Yasumasa Nishimura2 and Kazuhiko Nakagawa1
1Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
2Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
*These authors contributed equally to this work
Masayuki Takeda, email: firstname.lastname@example.org
Keywords: concurrent chemoradiotherapy, advanced esophageal cancer, dysphagia, survival, platinum doublet
Received: December 20, 2016 Accepted: May 03, 2017 Published: May 17, 2017
Platinum-based chemotherapy is considered a standard treatment option for patients with metastatic esophageal carcinoma. However, the overall survival of patients receiving such treatment is <1 year. A common presenting symptom of esophageal cancer is dysphagia, which has a substantial impact on quality of life. We have now retrospectively evaluated the efficacy and safety of palliative chemoradiotherapy for patients with stage IV esophageal cancer, most of whom are unfit for curative chemoradiotherapy. Fifty consecutive patients diagnosed with stage IV esophageal cancer were treated with concurrent chemoradiotherapy at Kindai University Hospital between April 2008 and December 2014. Most (90%) patients received a total radiation dose of at least 50 Gy, and the median number of treatment cycles per patient was four for the combination of 5-fluorouracil and cisplatin. The response of the primary tumor and the overall response were 80% and 44%, respectively. The dysphagia score was improved after chemoradiotherapy in 36 (72%) patients and did not change between before and after treatment in 14 (28%) patients. With a median follow-up time of 9.4 months from the start of chemoradiotherapy, the median progression-free survival and overall survival were 4.7 and 12.3 months, respectively. Three patients (T4b in two, T3 in one) developed esophagobronchial fistula after completion of chemoradiotherapy (n = 2) or after disease progression (n = 1), resulting in death in each case. Our results suggest that palliative chemoradioiotherapy was safe and contributed the improvement of dysphagia in patients with stage IV esophageal cancer.
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