The association of primary tumor site with acute adverse event and efficacy of definitive chemoradiotherapy for cStage I
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ORIGINAL ARTICLE
The association of primary tumor site with acute adverse event and efficacy of definitive chemoradiotherapy for cStage II/III esophageal cancer: an exploratory analysis of JCOG0909 Shuichi Hironaka1 · Azusa Komori1 · Ryunosuke Machida2 · Yoshinori Ito3 · Hiroya Takeuchi4 · Gakuto Ogawa2 · Ken Kato5 · Masakatsu Onozawa6 · Keiko Minashi7 · Tomonori Yano8 · Kenichi Nakamura2 · Takahiro Tsushima9 · Hiroki Hara10 · Isao Nozaki11 · Takashi Ura12 · Keisho Chin13 · Haruhiko Fukuda2 · Yuko Kitagawa14 Received: 20 January 2020 / Accepted: 21 April 2020 © The Japan Esophageal Society 2020
Abstract Background JCOG0909 is a phase II trial of definitive chemoradiotherapy including salvage treatment for cStage II–III thoracic esophageal cancer; the radiation field for elective regional lymph node irradiation, which can affect patient outcome and adverse event, varied based on the primary tumor site, i.e., upper (Ut), middle (Mt), and lower thoracic (Lt) esophagus. The impact of different primary sites on the safety and efficacy of definitive chemoradiotherapy in JCOG0909 is not well characterized. Methods Patients were categorized into three groups (Ut, Mt, and Lt) according to the primary tumor location. We compared acute adverse events during definitive chemoradiotherapy, complete response (CR) rate, 3-year progression-free survival (PFS), and overall survival (OS) among the 3 groups. Results Out of the 96 patients enrolled in JCOG0909 between April 2010 and August 2014, 94 patients (16, 59, and 19 patients in the Ut, Mt, and Lt groups, respectively) were included in this exploratory analysis. The proportion of patients with cStage III was 25% in the Ut, 37% in the Mt, and 47% in the Lt group. Grade 3–4 leukopenia, neutropenia, and thrombocytopenia were more frequently observed in the Mt (66%, 54%, and 15%) and Lt groups (84%, 68%, and 16%) than in the Ut group (38%, 44%, and 0%). There was no significant between-group difference with respect to 3-year OS (73.3%, 77.9%, and 57.9%), 3-year PFS (60.0%, 59.3%, and 47.4%), or CR rate (62.5%, 62.7%, and 42.1%). Conclusions In JCOG0909, the incidence of severe hematological toxicity had a trend toward higher in the Mt and Lt than the Ut esophageal cancer; however, no remarkable difference by primary sites was observed with respect to efficacy endpoints. Keywords Esophageal cancer · Location · Chemoradiotherapy · Primary site
Introduction Globally, esophageal cancer is the sixth most common cause of cancer-related deaths among men and the ninth most common cause of cancer-related deaths among women [1]. Neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is the global standard of care for patients with resectable esophageal cancer [2–6]. For patients who are unable or unwilling to undergo surgery, definitive chemoradiotherapy is the recommended treatment, both * Shuichi Hironaka shironaka@oita‑u.ac.jp Extended author information available on the last page of the article
for resectable esophageal cancer as well as for unresectable locally advan
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