Cancer oesophagus: is sequential chemo radiation better in elderly patients or patients with severe dysphagia?

Narendra Rathore, Poonam Chand Bana, Arvind Kumar Shukla, Abhay Kumar Jain, Vikram Singh Rajpurohit, Kiran Intodia


Background:This study was conducted to analyse the local control, regional control and toxicities of sequential versus concurrent chemo radiation in the patients of oesophageal cancer especially in elderly.

Methods: A total of newly diagnosed 50 patients were randomized in concurrent and sequential arm. Two courses of 3 weekly chemotherapy (Cisplatin and 5-FU based) were given concurrently and three courses of same chemotherapy were given neoadjuvantly with EBRT (44 Gys) respectively in randomised arms. HDR-ICBT (2 fractions of 5 Gy) delivered after two weeks of completion of EBRT in both arm.

Results: Concurrent arm had higher incidence of grade III+IV overall all toxicity especially in elderly patients or patients that presented with grade IV or higher dysphagia. Other haematological and non-haematological toxicities were equal in both arms. Complete response at both primary and mediastina was higher in concurrent arm but there was no statistically significant difference.

Conclusions: Our data suggest that if a patient can tolerate the combination of chemotherapy and radiation, this approach offers superior results but at the cost of higher incidence of severe toxicities especially in patients with grade IV or higher dysphagia or elderly patients. So this group could be treated with sequential chemo radiation.


Oesophageal cancer, Sequential chemo radiation, Neoadjuvant chemotherapy followed by radiation, Concurrent chemo radiation, Elderly, Severe dysphagia, Radiotherapy

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Omundsen M, Babor R, Johnston P. Outcomes after oesophagogastrectomy for carcinoma of the oesophagus. ANZ J Surg. 2007;77:37-9.

Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M et al. chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA. 1999;281:1623-7.

Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727-33.

Ilson DH, Ajani J, Bhalla K, Forastiere A, Huang Y, Patel P, et al. Phase II trial of paclitaxel, fluorouracil, and cisplatin in patients with advanced carcinoma of the esophagus. J Clin Oncol. 1998;16:1826-34.

Al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK et al. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol. 1997;15:277-84.

Vigneswaran WT, Trastek VF, Pairolero PC, Deschamps C, Daly RC, Allen MS. Transhiatal esophagectomy for carcinoma of the esophagus. Ann Thorac Surg. 1993;56:838-44.

Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593-8.

Gaspar LE, Qian C, Kocha WI, Coia LR, Herskovic A, Graham M. A phase I/II study of external beam radiation, brachytherapy and concurrent chemotherapy in localized cancer of the esophagus (RTOG 92-07): preliminary toxicity report. Int J Radiat Oncol Biol Phys. 1997;37:593-9.

Iizuka T. Surgical adjuvant treatment of esophageal carcinoma: a Japanese Esophageal Oncology Group experience. Semin Oncol. 1994;21:462-6.

Nakajima TE, Ura T, Ito Y, Kato K, Minashi K, Nihei K et al. A phase I trial of 5-fluorouracil with cisplatin and concurrent standard-dose radiotherapy in Japanese patients with stage II/III esophageal cancer. Jpn J Clin Oncol. 2009;39:37-42.

Cox JD, Stetz J, Pajak TF. 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;31:1341-6.

Trotti A, Colevas AD, Setser A, Rusch V, Jaques D, Budach V et al. CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol. 2003;3:176-81.