A national comparative effectiveness study to assess definitive chemoradiation regimens in proximal oesophageal squamous cell cancer

Date 29 September 2019
Event ESMO 2019 Congress
Session Poster Display session 2
Topics Oesophageal Cancer
Presenter Judith de Vos-Geelen
Citation Annals of Oncology (2019) 30 (suppl_5): v253-v324. 10.1093/annonc/mdz247
Authors J. de Vos-Geelen1, F.J.P. Hoebers2, S.M.E. Geurts1, A. Hoeben1, B.T.A. de Greef3, F.E.M. Voncken4, J.A. Bogers5, P.M. Braam6, C.T. Muijs7, M.A. de Jong8, N. Kasperts9, T. Rozema10, P.M. Jeene11, G.J. Blom12, M. Hulshof11, H.W.M. van Laarhoven13, H.I. Grabsch14, V.E.P.P. Lemmens15, V.C.G. Tjan-Heijnen1, G.A.P. Nieuwenhuijzen16
  • 1Dept. Of Internal Medicine, Div. Of Medical Oncology, Grow - School For Oncology And Developmental Biology, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 2Dept. Of Radiation Oncology (maastro), Grow – School For Oncology And Developmental Biology, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 3Dept. Of Clinical Epidemiology And Medical Technology Assessment (kemta), Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 4Dept. Of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital (NKI-AVL), 1066 CX - Amsterdam/NL
  • 5Dept. Of Radiation Oncology, Radiotherapiegroep Arnhem, 6815 AD - Arnhem/NL
  • 6Dept. Of Radiotherapy, RadboudUMC, 6500 HB - Nijmegen/NL
  • 7Dept. Of Radiotherapy, University Medical Center Groningen, 9700 RB - Groningen/NL
  • 8Dept. Of Clinical Oncology, Leiden University Medical Center, 2300 RC - Leiden/NL
  • 9Dept. Of Radiotherapy, University Medical Center Utrecht, 3508 GA - Utrecht/NL
  • 10Dept. Of Radiotherapy, Insituut Verbeeten, 5042 SB - Tilburg/NL
  • 11Dept. Of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ - Amsterdam/NL
  • 12Dept. Of Radiation Oncology, Amsterdam University Medical Centers, VU University, 1081 HV - Amsterdam/NL
  • 13Dept. Of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ - Amsterdam/NL
  • 14Pathology & Data Analytics, Leeds Institute of Medical Research at St James’s, University of Leeds, LS9 7TF - Leeds/GB
  • 15Integraal Kankercentrum Nederland, Integraal Kankercentrum Nederland, 5612 HZ - Eindhoven/NL
  • 16Dept. Of Surgery, Catharina Hospital Eindhoven, 5623 EJ - Eindhoven/NL

Abstract

Background

Proximal oesophageal cancer is commonly treated with definitive chemoradiation (CRT). The radiation dose and type of chemotherapy backbone in CRT are still under debate. The objective of this study is to compare the treatment benefit of four contemporary CRT regimens.

Methods

In this retrospective observational cohort study, we included patients with locally advanced squamous cell cancer of the proximal oesophagus, from 11 centers in the Netherlands, treated with definitive CRT between 2004-2014. Each center had a preferential CRT regimen, based on cisplatin (Cis) or carboplatin/paclitaxel (CP) combined with low (≤50.4 Gy) or high (>50.4 Gy) dose radiotherapy (RT). Differences in overall survival (OS) between CRT regimens were assessed using a fully adjusted Cox proportional hazards and propensity score (PS) model. Safety profiles were compared using the Chi-square test.

Results

Two-hundred patients were included. Fifty-four, 39, 95, and 12 patients were treated with Cis-low-dose RT, Cis-high-dose RT, CP-low-dose RT, and CP-high-dose RT, respectively. Median follow-up was 62.6 months (95% CI 47.9-77.2 months). Median OS (21.9 months; 95% CI 16.9-27.0 months) was comparable between treatment groups (logrank P = 0.88), confirmed in the fully adjusted and PS weighted model (P > 0.05). Grade 3-5 acute adverse events were less frequent in patients treated with CP-low-dose RT (P = 0.01).

Conclusions

Our study results suggest that carboplatin and paclitaxel combined with RT at a dose of 50.4 Gy is the preferred CRT regimen in patients with locally advanced proximal oesophageal squamous cell cancer, showing comparable OS and a significantly more favourable safety profile when compared with cisplatin-based or higher RT dose regimens.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

J. de Vos-Geelen: Travel / Accommodation / Expenses: BTG; Research grant / Funding (institution), Travel / Accommodation / Expenses: Servier; Advisory / Consultancy: Shire. B.T.A. de Greef: Research grant / Funding (institution): Prinses Beatrix Spierfonds (W.OR12-01). H.W.M. van Laarhoven: Advisory / Consultancy, Research grant / Funding (institution): BMS; Advisory / Consultancy, Research grant / Funding (institution): Celgene; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Advisory / Consultancy, Research grant / Funding (institution): Nordic; Research grant / Funding (institution): Bayer; Research grant / Funding (institution): Merck Serono; Research grant / Funding (institution): MSD; Research grant / Funding (institution): Philips; Research grant / Funding (institution): Roche. V.E.P.P. Lemmens: Research grant / Funding (institution): Roche. V.C.G. Tjan-Heijnen: Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Novartis; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Pfizer; Honoraria (self), Research grant / Funding (institution), Travel / Accommodation / Expenses: Lilly; Honoraria (self), Travel / Accommodation / Expenses: Accord Healthcare; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution): Eisai. All other authors have declared no conflicts of interest.