Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Outcome of Locally Advanced Esophageal Cancer Treated with Concurrent Chemo-radiotherapy

국소진행된 식도암에서 동시적 항암화학방사선요법의 결과

  • Jang, Hyun-Soo (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Kang, Seung-Hee (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Lee, Sun-Young (Department of Radiation Oncology, Gonyang University School of Medicine) ;
  • Jo, Sun-Mi (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Oh, Young-Taek (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Chun, Mi-Son (Departments of Radiation Oncology, Ajou University School of Medicine) ;
  • Choi, Jin-Hyuk (Departments of Medical Oncology, Ajou University School of Medicine) ;
  • Kang, Seok-Yun (Departments of Medical Oncology, Ajou University School of Medicine)
  • 장현수 (아주대학교 의과대학 방사선종양학교실) ;
  • 강승희 (아주대학교 의과대학 방사선종양학교실) ;
  • 이선영 (건양대학교 의과대학 방사선종양학교실) ;
  • 조선미 (아주대학교 의과대학 방사선종양학교실) ;
  • 오영택 (아주대학교 의과대학 방사선종양학교실) ;
  • 전미선 (아주대학교 의과대학 방사선종양학교실) ;
  • 최진혁 (아주대학교 의과대학 종양내과학교실) ;
  • 강석윤 (아주대학교 의과대학 종양내과학교실)
  • Received : 2009.04.03
  • Accepted : 2009.06.02
  • Published : 2009.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and Methods: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of $\geq$45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). Results: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. Conclusion: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.

목 적: 동시적 항암화학방사선치료를 받은 식도암 환자의 치료성적과 예후인자를 분석하였다. 대상 및 방법: 1994년 1월부터 2007년 7월까지 식도암으로 방사선치료를 받은 환자 246명 중 근치적 목적으로 45Gy이상의 방사선치료와 함께 동시적 항암화학요법을 받았으며 생존확인이 가능하였던 78명을 대상으로 후향적 분석을 시행하였다. AJCC 병기 IIA~IVB까지의 환자를 대상으로 하였는데, IVB는 상부식도암이 아닌 환자에서 쇄골상부림프절 전이가 있거나 하부식도암이 아닌 환자에서 복강림프절 전이가 있는 경우만을 포함시켰다. 방사선치료는 중앙값 54 Gy를 조사하였고, 항암화학요법은 대부분의 환자(88%)에서 5-FU와 cisplatin (FP) 병합요법으로 시행되었다. 추적관찰기간은 2~117개월(중앙값 14개월)이었다. 결 과: 흉부단층촬영이나 식도내시경을 통해 치료에 대한 반응을 확인할 수 있었던 54명의 환자중 완전관해가 17명, 부분관해가 18명이었다. 완전관해를 보인 환자에서 재발할 때까지의 기간은 중앙값 20개월이었고 첫 재발부위로 국소재발이 3명, 원격전이가 7명이었다. 1년, 2년, 5년 전체 생존률은 각각 58.9%, 21.7%, 12.2%이었고 중앙 생존기간은 14개월이었다. 전체 생존률에 대한 단변량분석에서 치료에 대한 반응과 FP병합요법의 횟수가 통계적인 유의성을 보여주었다. 환자의 숫자가 적었으나 방사선감작제로 일단위 혹은 주단위의 cisplatin이 FP 병합요법보다 좋은 결과를 보였다. 결 론: 원격장기로의 전이가 없는 국소진행성 식도암 환자에서 동시적 항암화학방사선치료는 기존의 연구와 유사한 결과를 보여주었다. 일단위 혹은 주단위의 cisplatin이 전신상태가 FP 병합요법에 적절하지 않은 환자에서 대안으로 사용될 수 있을 것으로 생각된다.

Keywords

References

  1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57:43-66 https://doi.org/10.3322/canjclin.57.1.43
  2. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979-1984 https://doi.org/10.1056/NEJM199812313392704
  3. Burmeister BH, Smithers BM, Gebski V, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol 2005;6:659-668 https://doi.org/10.1016/S1470-2045(05)70288-6
  4. Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term followup of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 1999;281:1623-1627 https://doi.org/10.1001/jama.281.17.1623
  5. Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 2002;20:1167-1174 https://doi.org/10.1200/JCO.20.5.1167
  6. Smith TJ, Ryan LM, Douglass HO Jr, et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys 1998; 42:269-276
  7. Miller AB, Hoogstraten B, Staquet M, Winkler A. Reporting results of cancer treatment. Cancer 1981;47:207-214 https://doi.org/10.1002/1097-0142(19810101)47:1<207::AID-CNCR2820470134>3.0.CO;2-6
  8. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341-1346 https://doi.org/10.1016/0360-3016(95)00060-C
  9. Herskovic A, Martz K, al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992; 326:1593-1598 https://doi.org/10.1056/NEJM199206113262403
  10. Rich TA, Ajani JA. High dose external beam radiation therapy with or without concomitant chemotherapy for esophageal carcinoma. Ann Oncol 1994;5(Suppl. 3):9-15
  11. Vermund H, Pories WJ, Hillard J, Wiley AL, Youngblood R. Neoadjuvant chemoradiation therapy in patients with surgically treated esophageal cancer. Acta Oncol 2001;40:558-565 https://doi.org/10.1080/028418601750444088
  12. Rich TA, Ajani JA, Morrison WH, Ota D, Levin B. Chemoradiation therapy for anal cancer: radiation plus continuous infusion of 5-fluorouracil with or without cisplatin. Radiother Oncol 1993;27:209-215 https://doi.org/10.1016/0167-8140(93)90076-K
  13. Schaake-Koning C, Maat B, van Houtte P, et al. Radiotherapy combined with low-dose cis-diammine dichloroplatinum (II) (CDDP) in inoperable nonmetastatic non-small cell lung cancer (NSCLC): a randomized three arm phase II study of the EORTC Lung Cancer and Radiotherapy Cooperative Groups. Int J Radiat Oncol Biol Phys 1990;19:967-972 https://doi.org/10.1016/0360-3016(90)90020-K
  14. Schaake-Koning C, van den Bogaert W, Dalesio O, et al. Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med 1992;326:524-530 https://doi.org/10.1056/NEJM199202203260805
  15. Sasamoto R, Sakai K, Inakoshi H, et al. Long-term results of chemoradiotherapy for locally advanced esophageal cancer, using daily low-dose 5-fluorouracil and cis-diammine-dichloroplatinum (CDDP). Int J Clin Oncol 2007;12:25-30 https://doi.org/10.1007/s10147-006-0617-y
  16. Hsu CH, Yeh KH, Lui LT, et al. Concurrent chemoradiotherapy for locally advanced esophageal cancer--a pilot study by using daily low-dose cisplatin and continuous infusion of 5-fluorouracil. Anticancer Res 1999;19:4463-4467
  17. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 2005;23: 2310-2317 https://doi.org/10.1200/JCO.2005.00.034
  18. Sur RK, Singh DP, Sharma SC, et al. Radiation therapy of esophageal cancer: role of high dose rate brachytherapy. Int J Radiat Oncol Biol Phys 1992;22:1043-1046 https://doi.org/10.1016/0360-3016(92)90805-R
  19. Vuong T, Szego P, David M, et al. The safety and usefulness of high-dose-rate endoluminal brachytherapy as a boost in the treatment of patients with esophageal cancer with external beam radiation with or without chemotherapy. Int J Radiat Oncol Biol Phys 2005;63:758-764 https://doi.org/10.1016/j.ijrobp.2005.02.042
  20. Gaspar LE, Qian C, Kocha WI, Coia LR, Herskovic A, Graham M. A phase I/II study of external beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 92-07): preliminary toxicity report. Int J Radiat Oncol Biol Phys 1997;37:593-599 https://doi.org/10.1016/S0360-3016(96)00591-3
  21. Gaspar LE, Winter K, Kocha WI, Coia LR, Herskovic A, Graham M. A phase I/II study of external beam radiation, brachytherapy, and concurrent chemotherapy for patients with localized carcinoma of the esophagus (Radiation Therapy Oncology Group Study 9207): final report. Cancer 2000;88:988-995 https://doi.org/10.1002/(SICI)1097-0142(20000301)88:5<988::AID-CNCR7>3.0.CO;2-U
  22. Noh OK, Kim SB, Lee GH, et al. Results of definitive chemoradiotherapy for unresectable esophageal cancer. J Korean Soc Ther Radiol Oncol 2008;22:25-32
  23. Liao Z, Zhang Z, Jin J, et al. Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients. Int J Radiat Oncol Biol Phys 2004;60:1484-1493 https://doi.org/10.1016/j.ijrobp.2004.05.056
  24. Bedenne L, Michel P, Bouche O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 2007;25:1160-1168 https://doi.org/10.1200/JCO.2005.04.7118
  25. Hennequin C, Gayet B, Sauvanet A, et al. Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus. Int J Radiat Oncol Biol Phys 2001;49:657-664 https://doi.org/10.1016/S0360-3016(00)01399-7
  26. Wang HW, Kuo KT, Wu YC, et al. Surgical results of upper thoracic esophageal carcinoma. J Chin Med Assoc 2004; 67:447-457
  27. Bates BA, Detterbeck FC, Bernard SA, Qaqish BF, Tepper JE. Concurrent radiation therapy and chemotherapy followed by esophagectomy for localized esophageal carcinoma. J Clin Oncol 1996;14:156-163 https://doi.org/10.1200/JCO.1996.14.1.156