title: Phase II study of concurrent chemoradiotherapy at the dose of 50.4 Gy with elective nodal irradiation for Stage II-III esophageal carcinoma.
abstract: OBJECTIVE
  Definitive chemoradiotherapy is one of the curative options for resectable esophageal squamous cell carcinoma with organ preservation. We evaluated the efficacy and toxicity of radiotherapy at a dose of 50.4 Gy concurrent with chemotherapy for Stage II-III esophageal cancer.
  
  
  METHODS
  Esophageal cancer patients with clinical Stage II-III (T1N1M0 or T2-3N0-1M0) were eligible. Radiotherapy was administered to a total dose of 50.4 Gy with elective nodal irradiation of 41.4 Gy. Concurrent chemotherapy comprised two courses of 5-fluorouracil (1000 mg/m(2)/day) on days 1-4 and 2-h infusion of cisplatin (75 mg/m(2)) on Day 1; this was repeated every 4 weeks. Two courses of 5-fluorouracil with cisplatin were added.
  
  
  RESULTS
  Fifty-one patients were enrolled in the study from June 2006 to May 2008. The characteristics of the 51 patients enrolled were as follows: median age 64 years; male/female, 45/6; performance status 0/1, 32/19 patients; Stage IIA/IIB/III, 9/20/22 patients, respectively. A complete response was achieved in 36 patients (70.6%). The 1- and 3-year overall survival rate was 88.2 and 63.8%, respectively. The median 1- and 3-year progression-free survival rate was 66.7% (80% CI: 57-74%) and 56.6% (80% CI: 47.1-64.9%), respectively. Acute toxicities included Grade 3/4 anorexia (45%), esophagitis (35%) and febrile neutropenia (20%). Eight patients (15.6%) underwent salvage surgery due to residual or recurrent disease. There were no deaths related to salvage surgery.
  
  
  CONCLUSIONS
  Chemoradiation therapy at a dose of 50.4 Gy with elective nodal irradiation is promising with a manageable tolerability profile in esophageal cancer patients.
authors.affiliation: Gastrointestinal Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. kenkato@ncc.go.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Kato
authors.forename: Takako Eguchi
authors.initials: TE
authors.lastname: Nakajima
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.forename: Chikatoshi
authors.initials: C
authors.lastname: Katada
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ishiyama
authors.forename: Shin-ya
authors.initials: SY
authors.lastname: Tokunaga
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tanaka
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hironaka
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Ura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D000855:Anorexia / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D004941:Esophagitis / Q000209:etiology; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D015182:Lymphatic Irradiation; D008875:Middle Aged; D009367:Neoplasm Staging; D009503:Neutropenia / Q000209:etiology; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: 50.4 Gy; chemoradiotherapy; elective nodal irradiation; esophageal squamous cell carcinoma; salvage surgery