Outcomes of induction chemotherapy followed by chemoradiation using intensity-modulated radiation therapy for esophageal adenocarcinoma Journal Article


Authors: Gerber, N.; Ilson, D. H.; Wu, A. J.; Janjigian, Y. Y.; Kelsen, D. P.; Zheng, J.; Zhang, Z.; Bains, M. S.; Rizk, N.; Rusch, V. W.; Goodman, K. A.
Article Title: Outcomes of induction chemotherapy followed by chemoradiation using intensity-modulated radiation therapy for esophageal adenocarcinoma
Abstract: This study looks at toxicity and survival data when chemoradiation (CRT) is delivered using intensity-modulated radiation therapy (IMRT) after induction chemotherapy. Forty-one patients with esophageal adenocarcinoma treated with IMRT from March 2007 to May 2009 at Memorial Sloan-Kettering Cancer Center were analyzed. All patients received induction chemotherapy prior to CRT. Thirty-nine percent (n = 16) of patients underwent surgical resection less than 4 months after completing CRT. Patients were predominantly male (78%), with a median age of 68 years (range 32-85 years). The majority of acute treatment-related toxicity was hematologic or gastrointestinal, with 17% of patients having grade 3+ hematologic toxicity and 12% of patients having grade 3+ gastrointestinal toxicity. Only two patients developed grade 2-3 pneumonitis (5%) and 5 patients experienced post-operative pulmonary complications (29%). Eight patients (20%) required a treatment break. With a median follow up of 41 months for surviving patients, 2-year overall survival was 61%, and the cumulative incidences of local failure (LF) and distant metastases were 40% and 51%, respectively. This rate of LF was reduced to 13% in patients who underwent surgical resection. Surgery and younger age were significant predictors of decreased time to LF on univariate analysis. Induction chemotherapy followed by CRT using IMRT in the treatment of esophageal cancer is well tolerated and is not associated with an elevated risk of postoperative pulmonary complications. The use of IMRT may allow for integration of more intensified systemic therapy or radiation dose escalation for esophageal adenocarcinoma, ultimately improving outcomes for patients with this aggressive disease. © 2013 Wiley Periodicals, Inc.
Keywords: adult; clinical article; aged; cancer surgery; survival rate; treatment failure; overall survival; fatigue; intensity modulated radiation therapy; fluorouracil; cancer combination chemotherapy; skin toxicity; paclitaxel; cancer radiotherapy; outcome assessment; follow up; infection; blood toxicity; esophagitis; nausea; vomiting; risk factor; distant metastasis; irinotecan; coughing; dyspnea; pneumonia; gastrointestinal toxicity; imrt; cardiotoxicity; predictor variable; platinum; mitomycin; esophageal adenocarcinoma; chemoradiotherapy; induction chemotherapy; radiation dose escalation; human; male; female; priority journal; article
Journal Title: Diseases of the Esophagus
Volume: 27
Issue: 3
ISSN: 1120-8694
Publisher: Oxford University Press  
Date Published: 2014-04-01
Start Page: 235
End Page: 241
Language: English
DOI: 10.1111/dote.12082
PROVIDER: scopus
PUBMED: 23796070
DOI/URL:
Notes: Export Date: 1 May 2014 -- CODEN: DIESE -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Zhigang Zhang
    428 Zhang
  2. Junting Zheng
    200 Zheng
  3. Valerie W Rusch
    865 Rusch
  4. Karyn A Goodman
    257 Goodman
  5. Nabil Rizk
    139 Rizk
  6. Yelena Yuriy Janjigian
    395 Janjigian
  7. Naamit Kurshan Gerber
    19 Gerber
  8. Abraham Jing-Ching Wu
    401 Wu
  9. David H Ilson
    434 Ilson
  10. Manjit S Bains
    338 Bains
  11. David P Kelsen
    537 Kelsen