Definitive chemoradiotherapy with low-dose continuous 5-fluorouracil reduces hematological toxicity without compromising survival in esophageal squamous cell carcinoma patients

To compare chemoradiotherapy (CRT) with low-dose continuous 5-fluorouracil (5FU) to CRT with 5FU+cisplatin (CDDP) for esophageal squamous cell carcinoma (ESCC) in a retrospective cohort study. We reviewed the cases of Stage I–IV ESCC patients who underwent definitive CRT in 2000–2014. Concomitant ch...

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Published inClinical and translational radiation oncology Vol. 9; no. C; pp. 12 - 17
Main Authors Saito, Hirotake, Ohta, Atsushi, Abe, Eisuke, Kaidu, Motoki, Shioi, Miki, Nakano, Toshimichi, Oshikane, Tomoya, Tanaka, Kensuke, Maruyama, Katsuya, Kushima, Naotaka, Tanabe, Satoshi, Utsunomiya, Satoru, Sasamoto, Ryuta, Aoyama, Hidefumi
Format Journal Article
LanguageEnglish
Published Ireland Elsevier B.V 01.02.2018
Elsevier
Subjects
5-Fluorouracil
Chemoradiotherapy
Cisplatin
Esophageal cancer
Hematological toxicity
Hematological toxicity
5-Fluorouracil
Chemoradiotherapy
Esophageal cancer
Cisplatin
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Summary:To compare chemoradiotherapy (CRT) with low-dose continuous 5-fluorouracil (5FU) to CRT with 5FU+cisplatin (CDDP) for esophageal squamous cell carcinoma (ESCC) in a retrospective cohort study. We reviewed the cases of Stage I–IV ESCC patients who underwent definitive CRT in 2000–2014. Concomitant chemotherapy was one of the three regimens: (1) high-dose intermittent 5FU and CDDP (standard-dose FP: SDFP), (2) low-dose continuous 5FU and CDDP (LDFP), or (3) low-dose continuous 5FU (LD5FU). The general selection criteria for chemotherapy were: SDFP for patients aged <70 yrs; LDFP for those aged 70–74 yrs; LD5FU for those aged ≥75 yrs or with performance status (PS) ≥3. Propensity scores were derived with chemotherapy (LD5FU vs. 5FU+CDDP) as the dependent variable. In a multivariate analysis, chemotherapy (LD5FU vs. SDFP, p = .24; LDFP vs. SDFP, p = .52) did not affect the overall survival (OS). LD5FU caused significantly less grade 3–4 leukopenia (9%) compared to SDFP (47%) and LDFP (44%) (p < .001). In a propensity-matched analysis, LD5FU affected neither OS (HR 1.06; 95%CI 0.55–2.05; p = .87) nor progression-free survival (HR 0.95, 95%CI 0.50–1.81; p = .87). CRT with low-dose continuous 5FU may be a less toxic option for elderly ESCC patients.
ISSN:2405-6308
2405-6308
DOI:10.1016/j.ctro.2017.12.003