title: Efficacy and Safety of Induction Chemotherapy in Esophageal Cancer with Airway Involvement.
abstract: OBJECTIVE
  Esophageal cancer with tracheobronchial involvement (TBI) has a poor prognosis. Radical therapy carries the risk of inducing tracheoesophageal fistula (TEF) and treatment-related mortality. Induction chemotherapy followed by reassessment for radical therapy may decrease morbidity and improve outcome.
  
  
  METHODS
  This is a retrospective analysis of esophageal cancer patients with TBI who received induction chemotherapy. Airway involvement was defined as bronchoscopic appearance of a bulge into the lumen, restricted or immobile mucosa, frank infiltration, TEF, or stridor, which was clinically due to airway obstruction from the esophageal lesion.
  
  
  RESULTS
  Eighty-three patients were included over 5 years; 97.6 % had squamous histology. All patients received taxane and platinum combination induction chemotherapy; 90.5 % of patients received chemotherapy without dose delays, and 77.8 % patients did not require a dose reduction or modification. The 31.7 % patients had a clinically significant ≥grade 3 toxicity. The objective response rate was 67 % among the patients who underwent restaging scans following induction chemotherapy; 79.5 % of the patients could receive radical intent therapy, either concurrent chemoradiotherapy, or radiation alone, or surgery in one patient. The TEF complication rate was 6 % during the course of therapy. At a median follow-up of 28 months in surviving patients, the estimated median PFS was 8 months (95 % CI 5.5-10.5) and the estimated median OS was 17 months (95 % CI 5.6-28.4). Patients who received radical therapy had a significantly better PFS and OS, p = 0.000.
  
  
  CONCLUSIONS
  Induction chemotherapy may improve the outcome of patients with esophageal cancer involving the airway and may help select patients for curative treatment and lower the risk of TEF development.
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India.
authors.forename: Vanita
authors.initials: V
authors.lastname: Noronha
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Patil
authors.affiliation: Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, India.
authors.forename: Nilendu
authors.initials: N
authors.lastname: Purandare
authors.affiliation: Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Sabita
authors.initials: S
authors.lastname: Jiwnani
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India.
authors.forename: Dipti
authors.initials: D
authors.lastname: Nakti
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India.
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Bandekar
authors.affiliation: Department of Medical Oncology, Tata Memorial Hospital, Dr. E Borges Marg, Parel, Mumbai, 400012, India. kumarprabhashtmh@gmail.com.
authors.forename: Kumar
authors.initials: K
authors.lastname: Prabhash
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D014132:Trachea / Q000473:pathology*; D014138:Tracheoesophageal Fistula / Q000473:pathology*
keywords: Airway invasion; Chemoradiotherapy; Esophageal neoplasms; Esophagus; Induction chemotherapy; T4; Taxane; Tracheoesophageal fistula