Preoperative high-dose radiation and chemotherapy in adenocarcinoma of the esophagus and esophagogastric junction

Edward R. Sauter, Lawrence R. Coia, Steven M. Keller

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Esophageal adenocarcinoma (EA) incidence is rising. Defining optimal management is essential because median survival after surgery alone is only ∼12 months. High-dose radiation (>5000 cGy) and chemotherapy (HDRCT) preoperatively for patients with EA has not been fully investigated. We evaluated tumor response, resectability, and survival following HDRCT in patients with localized EA. Methods: Thirty patients with American Joint Committee on Cancer (AJCC) clinical stage I or II EA were prospectively treated with HDRCT. The treatment consisted of 60 Gy radiation at 2 Gy per fraction with concurrent infusional 5-fluorouracil (5-FU) and a bolus of mitomycin C followed by esophagogastrectomy. The range of follow-up was 7 to 69 months, with a median of 31 months. Results: Twenty of 30 patients (67%) received full-course HDRCT. Severe esophagitis precluded full-dose radiation in 10 patients. Three patients developed neutropenia and fever requiring admission to a hospital. Two patients died preoperatively of treatment-related complications. Nine patients were not explored. Eighteen patients were resected with curative intent; the remaining three had metastatic disease at laparotomy. Seven of 18 resected patients (39%), or 7/30 (23%) of all patients treated, had a pathologic complete response. There was one operative death. Overall local control was seen in 25/30 patients (83%). Median overall survivals for resected and for all patients were 23 and 13 months, respectively. Conclusions: Preoperative HDRCT in patients with EA results in encouraging local tumor response and local control. Overall survival, however, may not be improved, and the treatment-related mortality of 10% is higher than reported with surgery alone or with preoperative chemotherapy.

Original languageEnglish (US)
Pages (from-to)5-10
Number of pages6
JournalAnnals of Surgical Oncology
Volume1
Issue number1
DOIs
StatePublished - Jan 1994
Externally publishedYes

Fingerprint

Esophagogastric Junction
Radiation
Drug Therapy
Adenocarcinoma
Survival
Adenocarcinoma Of Esophagus
Radiation Dosage
Neoplasms
Esophagitis
Mitomycin
Neutropenia
Fluorouracil
Laparotomy

Keywords

  • Carcinoma, esophageal
  • Chemotherapy, preoperative
  • Radiation, preoperative

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Preoperative high-dose radiation and chemotherapy in adenocarcinoma of the esophagus and esophagogastric junction. / Sauter, Edward R.; Coia, Lawrence R.; Keller, Steven M.

In: Annals of Surgical Oncology, Vol. 1, No. 1, 01.1994, p. 5-10.

Research output: Contribution to journalArticle

Sauter, Edward R. ; Coia, Lawrence R. ; Keller, Steven M. / Preoperative high-dose radiation and chemotherapy in adenocarcinoma of the esophagus and esophagogastric junction. In: Annals of Surgical Oncology. 1994 ; Vol. 1, No. 1. pp. 5-10.
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abstract = "Background: Esophageal adenocarcinoma (EA) incidence is rising. Defining optimal management is essential because median survival after surgery alone is only ∼12 months. High-dose radiation (>5000 cGy) and chemotherapy (HDRCT) preoperatively for patients with EA has not been fully investigated. We evaluated tumor response, resectability, and survival following HDRCT in patients with localized EA. Methods: Thirty patients with American Joint Committee on Cancer (AJCC) clinical stage I or II EA were prospectively treated with HDRCT. The treatment consisted of 60 Gy radiation at 2 Gy per fraction with concurrent infusional 5-fluorouracil (5-FU) and a bolus of mitomycin C followed by esophagogastrectomy. The range of follow-up was 7 to 69 months, with a median of 31 months. Results: Twenty of 30 patients (67{\%}) received full-course HDRCT. Severe esophagitis precluded full-dose radiation in 10 patients. Three patients developed neutropenia and fever requiring admission to a hospital. Two patients died preoperatively of treatment-related complications. Nine patients were not explored. Eighteen patients were resected with curative intent; the remaining three had metastatic disease at laparotomy. Seven of 18 resected patients (39{\%}), or 7/30 (23{\%}) of all patients treated, had a pathologic complete response. There was one operative death. Overall local control was seen in 25/30 patients (83{\%}). Median overall survivals for resected and for all patients were 23 and 13 months, respectively. Conclusions: Preoperative HDRCT in patients with EA results in encouraging local tumor response and local control. Overall survival, however, may not be improved, and the treatment-related mortality of 10{\%} is higher than reported with surgery alone or with preoperative chemotherapy.",
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AB - Background: Esophageal adenocarcinoma (EA) incidence is rising. Defining optimal management is essential because median survival after surgery alone is only ∼12 months. High-dose radiation (>5000 cGy) and chemotherapy (HDRCT) preoperatively for patients with EA has not been fully investigated. We evaluated tumor response, resectability, and survival following HDRCT in patients with localized EA. Methods: Thirty patients with American Joint Committee on Cancer (AJCC) clinical stage I or II EA were prospectively treated with HDRCT. The treatment consisted of 60 Gy radiation at 2 Gy per fraction with concurrent infusional 5-fluorouracil (5-FU) and a bolus of mitomycin C followed by esophagogastrectomy. The range of follow-up was 7 to 69 months, with a median of 31 months. Results: Twenty of 30 patients (67%) received full-course HDRCT. Severe esophagitis precluded full-dose radiation in 10 patients. Three patients developed neutropenia and fever requiring admission to a hospital. Two patients died preoperatively of treatment-related complications. Nine patients were not explored. Eighteen patients were resected with curative intent; the remaining three had metastatic disease at laparotomy. Seven of 18 resected patients (39%), or 7/30 (23%) of all patients treated, had a pathologic complete response. There was one operative death. Overall local control was seen in 25/30 patients (83%). Median overall survivals for resected and for all patients were 23 and 13 months, respectively. Conclusions: Preoperative HDRCT in patients with EA results in encouraging local tumor response and local control. Overall survival, however, may not be improved, and the treatment-related mortality of 10% is higher than reported with surgery alone or with preoperative chemotherapy.

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