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

摘要

BackgroundThe 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 Methods67 Patients with clinical stage II-IVa ESCC were enrolled. The total dose of SLN CFRT was 60Gy in 30 fractions over 6weeks. The first course of radiation covered the primary and metastatic regional tumors and high-risk lymph nodal regions, given at 2Gy/fraction for a dose of 40Gy. In the second course, CFRT was delivered to the boost volume for an additional 20Gy in 10days, using 2Gy/fraction. Two cycles of chemotherapy were given at the beginning of radiotherapy. CDDP at 25mg/m(2)/day was given on days 1-3 and days 22-24, and S-1 at 80mg/m(2)/day on days 1-14 and days 22-35. Patients achieving objective response after concurrent chemoradiotherapy underwent two additional cycles of chemotherapy.ResultsThe 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 32months, the overall survival (OS) and progression-free survival (PFS) at 1year and 2years were 81.0% and 73.0%, and 63.5% and 49.2%, respectively.ConclusionsSLN RT concurrent with S-1 plus CDDP may represent a better strategy for treatment of ESCC patients.