Survival Outcomes and Toxicity of Concurrent Chemoradiotherapy for Esophageal Cancer

Aims: The aim of the study was to investigate the impact of chemoradiotherapy(CRT) on survival of patients with unresectable esophageal cancer treated with radiotherapy combined with either concurrent DCF [docetaxel, cisplatin +5-fluorouracil(5-FU)] or CF [cisplatin and 5-FU).Patients and methods:Data of patients who underwent CRT for esophageal cancer during 2010 and 2015 in the department of Clinical Oncology, Assiut University Hospital, Egypt were collected. Patients received either CF every 4-week, cisplatin (75 mg/m2) on day 1 followed by 5-fluorouracil (5-FU) 1000 mg/m2/24 h IV on days 1-4 for 4 cycles or DCF as IV infusions of docetaxel (40 mg/m2), cisplatin (40 mg/m2) on day 1 and 5-FU (400 mg/m2/day) on days 1 to 5, every 2 weeks for 3 cycles. Both groups received 50 Gy of radiotherapy in 25 fractions.Results: We identified 51 patients. The mean progression-free survival (PFS) and overall survival (OS) of the cohort were 19.83 and 29.30 months respectively. Improved OS was achieved with stratification according to T3/N+/stage III with DCF (20 patients) in comparison with CF (31 patients). Grade 3-4 leucopoenia (22.6% vs. 60.6%) and febrile neutropenia (16% vs. 30%) were significantly higher in DCF groupConclusions:Our data suggest that CRT has a role in improving survival of patients with esophageal cancer. DCF therapy compared with CF improved OS in locally advanced esophageal cancer patients. Mohamed-Alaa-Eldeen Hassan Mohamed * Department of Clinical Oncology and Nuclear medicine, Faculty of medicine, Assiut University, Egypt Submission: 25 August 2017 Accepted: 3 September 2017 Published: 30 September 2017 www.ijsrm.humanjournals.com Citation: Mohamed-Alaa-Eldeen Hassan Mohamed et al. Ijsrm.Human, 2017; Vol. 7 (3): 83-96. 84 INTRODUCTION Esophageal cancer (EC) is the eighth common cancer in the world and the sixth cause of death from cancer worldwide 1, 2 .The incidence of EC is more in less developed and developing countries 3 . Chemoradiotherapy for stage II–IIIesophageal cancer, showed a completeresponse rate of 62.2% and 5-year survival of36.8% 4 . The common radiosensitizers in EC iscisplatin and 5-fluorouracil. However, the outcomes of this regimen remain unsatisfactory 5 .Studies have reported encouraging results for docetaxel and cisplatinin EC and radiotherapy 6, 7 . The aim of this study was to investigate the impact of concurrent chemoradiation on survival of patients withlocoregionalesophageal cancer retrospectively and to compare the efficacy and toxicities of cisplatin+ 5-fluorouracil versus docetaxel, cisplatin and 5-fluorouracil regimens. Patients and methods In this observational study, the medical record of patients diagnosed withunresectable thoracic esophageal cancer who received concurrent chemoradiotherapyas a primary treatment with either cisplatin-5-fluorouracil (CF) or docetaxel-cisplatin-5-fluorouracil (DCF),at Clinical Oncology department, Assiut University Hospital, Egypt between January 2010 and December 2015 were retrospectively reviewed. Study eligibility included patients with biopsy-proven esophageal cancer (squamous cell carcinoma or adenocarcinoma), stage II or III according to the American Joint Committee on Cancer (AJCC) 8 staging system 7 th edition with Easter Cooperative Oncology Group performance status ≤2. Exclusion criteria included patients treated with other concurrent chemoradiotherapy regimen, patients who received induction chemotherapy and patients with distant metastases. The protocol of the study was approved by the ethics committee of Assiut University, Egypt before the study was activated. The treatment was applied in accordance with the Declaration of Helsinki with a written informed consent was obtained from all patients. www.ijsrm.humanjournals.com Citation: Mohamed-Alaa-Eldeen Hassan Mohamed et al. Ijsrm.Human, 2017; Vol. 7 (3): 83-96. 85 Radiotherapy and chemotherapy In the PF group, two cycles of 5-fluorouracil and cisplatin were given during radiotherapy at 4-week intervals. 2-hour infusion of cisplatin (75 mg/m 2 ) was administered on day 1 with standard hydration, followed by 5-fluorouracil 1000 mg/m 2 /24 h by continuous intravenous infusion on days 1-4 of each cycle. Patients had a 4-week rest after the completion of radiation and then received an additional two cycles of chemotherapy. Patients who had T3 tumor or lymph node metastases that were diagnosed between 2014 and 2015 received DCF combination regimen. Patients received intravenous infusions of docetaxel (40 mg/m 2 ) and cisplatin (40 mg/m 2 ) on day 1 and a continuous intravenous infusion of 5-fluorouracil (400 mg/m 2 /day) on days 1 to 5, every 2 weeks, plusconcurrentradiation for 3 cycles. Radiotherapy was started on day 1 concomitantly with chemotherapy in both groups. Thesuperior and inferior extent of the tumor was defined by simulator with barium swallow. The length of the target volume was chosen to allow a 5 cm margin superior and inferior to tumor limits and 2 cm lateral marginwas used to include soft tissue disease in the esophageal wall. Radiotherapy was delivered with linear accelerator (6 MV) or cobalt-60 machines to a doseof 45Gy, 2Gy/fraction, 5 fractions per week over 4.5 weeks by anterior and posterior opposing fields. Two-dimensional treatment planning was used.