Concurrent Selective Lymph Node Radiotherapy and S-1 Plus Cisplatin for Esophageal Squamous Cell Carcinoma: A Phase II Study.

Abstract:

BACKGROUND:The efficacy, toxicity, and patterns of failure of esophageal squamous cell carcinoma (ESCC) treated with selective lymph node (SLN) conventional fraction radiotherapy (CFRT) and S-1 plus cisplatin (CDDP) were evaluated. PATIENTS AND METHODS:67 Patients with clinical stage II-IVa ESCC were enrolled. The total dose of SLN CFRT was 60 Gy in 30 fractions over 6 weeks. The first course of radiation covered the primary and metastatic regional tumors and high-risk lymph nodal regions, given at 2 Gy/fraction for a dose of 40 Gy. In the second course, CFRT was delivered to the boost volume for an additional 20 Gy in 10 days, using 2 Gy/fraction. Two cycles of chemotherapy were given at the beginning of radiotherapy. CDDP at 25 mg/m2/day was given on days 1-3 and days 22-24, and S-1 at 80 mg/m2/day on days 1-14 and days 22-35. Patients achieving objective response after concurrent chemoradiotherapy underwent two additional cycles of chemotherapy. RESULTS:The objective response rate (ORR) was 82.5%. Grade 3 or 4 toxicities included leukopenia (23.8%), neutropenia (14.3%), thrombocytopenia (14.3%), hemoglobin (4.8%), gastrointestinal (12.7%), skin (1.6%), and esophagus fistula (1.6%). One patient died of severe pneumonia, and two died of late toxicity because of esophagus fistula. With median follow-up of 32 months, the overall survival (OS) and progression-free survival (PFS) at 1 year and 2 years were 81.0% and 73.0%, and 63.5% and 49.2%, respectively. CONCLUSIONS:SLN RT concurrent with S-1 plus CDDP may represent a better strategy for treatment of ESCC patients.

journal_name

Ann Surg Oncol

authors

Wang X,Liu X,Li D,Wang X,Huang W,Li B

doi

10.1245/s10434-019-07264-4

subject

Has Abstract

pub_date

2019-06-01 00:00:00

pages

1886-1892

issue

6

eissn

1068-9265

issn

1534-4681

pii

10.1245/s10434-019-07264-4

journal_volume

26

pub_type

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