Radiation Oncology Journal

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

DOI QR Code

Concurrent Chemoradiotherapy in Elderly Patients with Locally Advanced Esophageal Carcinoma

고령의 국소 진행된 식도암환자에서 동시 항암화학방사선치료

  • Jung, Bae-Kwon (Departments of Radiation Oncology, School of Medicine, Gyeongsang National University) ;
  • Kang, Ki-Mun (Departments of Radiation Oncology, School of Medicine, Gyeongsang National University) ;
  • Lee, Gyeong-Won (Internal Medicine, School of Medicine, Gyeongsang National University) ;
  • Kang, Jung-Hoon (Internal Medicine, School of Medicine, Gyeongsang National University) ;
  • Kim, Hoon-Gu (Internal Medicine, School of Medicine, Gyeongsang National University) ;
  • Lee, Won-Seob (Internal Medicine, School of Medicine, Gyeongsang National University) ;
  • Chai, Gyu-Young (Departments of Radiation Oncology, School of Medicine, Gyeongsang National University)
  • 정배권 (경상대학교 의학전문대학원 방사선종양학교실) ;
  • 강기문 (경상대학교 의학전문대학원 방사선종양학교실) ;
  • 이경원 (경상대학교 의학전문대학원 종양내과학교실) ;
  • 강정훈 (경상대학교 의학전문대학원 종양내과학교실) ;
  • 김훈구 (경상대학교 의학전문대학원 종양내과학교실) ;
  • 이원섭 (경상대학교 의학전문대학원 종양내과학교실) ;
  • 채규영 (경상대학교 의학전문대학원 방사선종양학교실)
  • Received : 2009.04.30
  • Accepted : 2009.06.09
  • Published : 2009.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The effect of concurrent chemoradiotherapy was analyzed in elderly patients when used in the treatment of locally advanced esophageal cancer. Materials and Methods: The retrospective analysis included 28 elderly patients aged 65 or older, with histopathologically confirmed squamous cell carcinoma of the esophagus, underwent concurrent chemoradiotherapy from January 2001 to July 2007. The squamous cell carcinoma disease stages included 8 patients (28.8%) in stage IIa, 10 patients (35.7%) in stage IIb, and 10 patients (35.7%) in stage III. Fractionated radiotherapy was performed with a 6 MV or 10 MV X-ray for 45~63 Gy (median: 59.4 Gy). Chemotherapy was applied concurrently with the initiation of radiotherapy. A 75 mg/$m^2$ dose of Cisplatin was intravenously administered on day 1. Further, 5-FU 1,000 mg/$m^2$ was continuously administered intravenously from days 1 to 4. This regimen was performed twice at 3-week intervals during radiotherapy. Two cycles of consolidation chemotherapy was performed after radiotherapy. Results: The follow-up period was 3~72 months (median: 19 months). The treatment responses after concurrent chemoradiotherapy included a complete response in 11 patients (39.3%), a partial response in 14 patients (50.0%), and no response in 3 patients (10.7%). The overall response rate was 89.3% (25 patients). The overall 1-, 2- and 3-year survival rates were 55.9%, 34.6% and 24.2%, respectively. The median survival time was 15 months. Two-year survival rates of patients with a complete response, partial response, and no response were 46.2%, 33.0%, and 0%, respectively. The stage and tumor response after concurrent chemoradiotherapy were statistically significant prognostic factors related with survival. No treatment-related deaths occurred in this study. Conclusion: Concurrent chemoradiotherapy is a relatively effective treatment without serious complications in elderly patients with locally-advanced esophageal cancer.

목 적: 국소 진행된 식도암으로 동시 항암화학방사선치료를 시행한 고령의 환자들을 대상으로 동시 항암화학방사선치료에 대한 효과를 알아보고자 하였다. 대상 및 방법: 2001년 1월부터 2007년 7월까지 병리학적 편평상피세포암으로 확인 된 65세 이상의 식도암 환자 중동시 항암화학방사선치료를 받은 28명을 대상으로 후향적 분석을 하였다. 환자의 병기는 IIa 8명(28.8%), IIb 10명 (35.7%), III 10명(35.7%)이었다. 방사선치료는 6 MV 또는 10 MV X-선으로 45~63 Gy (중앙값: 59.4 Gy)를 분할 조사하였다. 항암화학요법은 방사선치료 시작과 동시에 Cisplatin 75 mg/$m^2$을 제1일에 정주하였고, 5-FU는 1,000mg/$m^2$을 제1일에서 제4일까지 4일간 지속적 정주하여 방사선치료 동안은 3주 간격으로 2회 시행하였고, 방사선치료 후 2회의 항암화학요법을 추가 시행하였다. 결 과: 추적관찰기간은 3~72개월(중앙값: 19개월)이었다. 동시 항암화학방사선치료 후 치료 반응은 완전관해가39.3% (11명), 부분반응은 50.0% (14명), 무반응이 10.7% (3명)로 치료 반응률은 89.3% (25명)이었다. 전체 환자의 1, 2, 3년 생존율은 각각 55.9%, 34.6%, 24.2%이었고 중앙 생존기간은 15개월이었다. 완전관해, 부분반응, 무반응의 종양 반응을 보인 환자들의 2년 생존율은 각각 46.2%, 33.%, 0%이었다. 생존율과 관련된 예후인자로서 병기와 방사선치료 후 종양 반응이 유의하였다. 치료에 의한 합병증으로 사망한 환자는 없었다. 결 론: 고령의 국소 진행된 식도암환자에 대한 동시 항암화학방사선치료는 심각한 부작용 없이 비교적 효과적이었다.

Keywords

References

  1. Schattenkerk ME, Obertop H, Mud HJ, Eijkenboom WM, van Andel JG, van Houten H. Survival after resection for carcinoma of the oesophagus. Br J Surg 1987;74:165-168 https://doi.org/10.1002/bjs.1800740305
  2. Teniere P, Hay JM, Fingerhut A, Fagniez PL. Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research. Surg Gynecol Obstet 1991;173:123-130
  3. Petrovich Z, Langholz B, Formenti S, Luxton G, Astrahan M. Management of carcinoma of the esophagus: the role of radiotherapy. Am J Clin Oncol 1991;14:80-86 https://doi.org/10.1097/00000421-199102000-00018
  4. Sun DR. Ten-year follow-up of esophageal cancer treated by radical radiation therapy: analysis of 869 patients. Int J Radiat Oncol Biol Phys 1989;16:329-334 https://doi.org/10.1016/0360-3016(89)90324-6
  5. Hennequin C, Maylin C. Continuous radiosensitizing chemotherapy. Pathol Biol 1999;47:279-281
  6. Cmelak AJ, Murphy BA, Day T. Combined-modality therapy for locoregionally advanced head and neck cancer. Oncology 1999;13:83-91
  7. Pisch J, Berson AM, Malamud S, Beattie EJ, Harvey J, Vikram B. Chemoradiation in advanced nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1995;33:183-188 https://doi.org/10.1016/0360-3016(94)00616-S
  8. Rich T. Chemoradiation in conservation therapy for esophageal cancer. Hematol Oncol Clin North Am 2001;15:291-302 https://doi.org/10.1016/S0889-8588(05)70213-6
  9. James K, Eisenhauer E, Christian M, et al. Measuring response in solid tumors: unidimensional versus bidimensional measurement. J Natl Cancer Inst 1999;91:523-528 https://doi.org/10.1093/jnci/91.6.523
  10. Cox J, Stetz J, Pajak T. 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
  11. Kaplan E, Meier P. Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481
  12. Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol 2007;25:4110-4117 https://doi.org/10.1200/JCO.2007.12.0881
  13. Kelsen DP. Multimodality therapy of local regional esophageal cancer. Semin Oncol 2005;32:6-10
  14. van Lanschot JJ, Aleman BM, Richel DJ. Esophageal carcinoma: surgery, radiotherapy, and chemotherapy. Curr Opin Gastroenterol 2002;18:490-495 https://doi.org/10.1097/00001574-200207000-00015
  15. Nam TK, Nah BS, Chung WK, Ahn SJ, Song JY. Results of concurrent chemoradiotherapy and intraluminal brachytherapy in esophageal carcinoma - retrospective analysis with respect to survival. J Korean Soc Ther Radiol Oncol 2004;22:25-32
  16. Noh OK, Je HU, Kim SB, et al. Results of definitive chemoradiotherapy for unresectable esophageal cancer. J Korean Soc Ther Radiol Oncol 2008;26:195-203 https://doi.org/10.3857/jkstro.2008.26.4.195
  17. Minsky BD, Neuberg D, Kelsen DP, et al. Final report of Intergroup Trial 0122 (ECOG PE-289, RTOG 90-12): phase II trial of neoadjuvant chemotherapy plus concurrent chemotherapy and high-dose radiation for squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 1999;43:517–523
  18. Coia LR, Minsky BD, Berkey BA, et al. Outcome of patients receiving radiation for cancer of the esophagus: results of the 1992–1994 patterns of care study. J Clin Oncol 2000;18: 455–462
  19. 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
  20. 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
  21. Anderson SE, Minsky BD, Bains M, Hummer A, Kelsen D, Ilson DH. Combined modality chemoradiation in elderly oesophageal cancer patients. Br J Cancer 2007;96:1823–1827
  22. Takeuchi S, Ohtsu A, Doi T, et al. A retrospective study of definitive chemoradiotherapy for elderly patients with esophageal cancer. Am J Clin Oncol 2007;30:607–611
  23. Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 2004;240:791–800
  24. Moskovitz AH, Rizk NP, Venkatraman E, et al. Mortality increases for octogenarians undergoing esophagogastrectomy for esophageal cancer. Ann Thorac Surg 2006;82:2031–2036
  25. Ruol A, Portale G, Castoro C, et al. Management of esophageal cancer in patients aged over 80 years. Eur J Cardiothorac Surg 2007;32:445–448
  26. Tougeron D, Di Fiore F, Hamidou H, Rigal O, Paillot B, Michel P. Response to definitive chemoradiotherapy and survival in patients with an oesophageal adenocarcinoma vs squamous cell carcinoma: a matchedpair analysis. Oncology 2008;73:328–334
  27. Burtin P, Bouche O, Giovannini M, et al. Endoscopic ultrasonography is an independent predictive factor of prognosis in locally advanced esophageal cancer. Results from the randomized FFCD 9102 study from the Federation Francophone de Cancerologie Digestive. Gastroenterol Clin Biol 2008;32:213–220
  28. Popescu RA, Norman A, Ross PJ, Parikh B, Cunningham D. Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. J Clin Oncol 1999;17:2412–2418
  29. Trumper M, Ross PJ, Cunningham D, et al. Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophagogastric cancer: a pooled analysis of three clinical trials. Eur J Cancer 2006;42:827–834
  30. Pasetto LM, Friso ML, Pucciarelli S, et al. Rectal cancer neoadjuvant treatment in elderly patients. Anticancer Res 2006; 26:3913–3923
  31. Semrau S, Bier A, Thierbach U, et al. 6-year experience of concurrent radiochemotherapy with vinorelbine plus a platinum compound in multimorbid or aged patients with inoperable nonsmall cell lung cancer. Strahlenther Onkol 2007;183:30–35
  32. Polee MB, Hop WCJ, Kok TC, et al. Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatin-based combination chemotherapy. Br J Cancer 2003;89:2045–2050