Boers, J. (Jorianne) (2015) Hoge dosis neoadjuvante chemoradiotherapie bij potentieel resectabel oesophaguscarcinoom: een retrospectief cohortonderzoek. thesis, Medicine.
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Abstract
Background: The standard treatment for potentially resectable esophageal cancer consists of five cycles of carboplatin and paclitaxel with concurrent radiotherapy (41,4 Gy), followed by esophagectomy. This treatment regimen yields a 5-year disease-free survival rate of 44%. It remains unclear whether dose-intensification leads to better outcomes. The aim of this study is to analyze the disease-free survival and toxic effects of a high dose of chemoradiation. Methods: The medical records of patients treated between January 2008 and December 2014 were studied retrospectively. The neoadjuvant therapy consisted of six cycles of carboplatin (area under the curve = 2 mg/ml/min) and paclitaxel (50 mg/m2 of body-surface area) and concurrent radiotherapy (50,4 Gy given in 28 fractions of 1,8 Gy each, 5 days per week), followed by esophagectomy. Results: A total of 181 patients were included, of which 72% underwent a resection. At a median follow-up of 26,3 months, the patients who underwent a resection had not yet reached the median disease-free survival time. The disease-free survival rates at 3 and 5 years were 56% and 52%, respectively. The median overall survival time was 43,5 months and the overall survival rates at 3 and 5 years were 56% and 44%, respectively. The most common grade ≥ 3 acute toxicity due to the chemoradiation was leukopenia (29%). The most common postoperative complications were anastomotic leakage and pulmonary complications (both 29%). The postoperative mortality rate within 30 days after surgery was 4%. A microscopically radical resection was achieved in 81% of patients and a pathological complete response in 35%. Conclusions: Neoadjuvant chemoradiation consisting of six cycles of carboplatin and paclitaxel with concurrent radiotherapy (50,4 Gy) for patients with potentially resectable esophageal cancer is well tolerated. In addition, the pathological complete response rate was relatively high. A randomized trial is needed to determine the effects of this regimen.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | facultair begeleider: and Groot, dr. J.W.B. de internist-oncoloog |
| Supervisor name: | overige begeleiders: and Timmer, dr. P.R. radiotherapeut-oncoloog and Braam-Joldersma, mw. A. physician assistant chirurgie and Locatie: Isala te Zwolle, afdeling interne geneeskunde |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/779 |
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