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

Hirotake Saito; Atsushi Ohta; Eisuke Abe; Motoki Kaidu; Miki Shioi; Toshimichi Nakano; Tomoya Oshikane; Kensuke Tanaka; Katsuya Maruyama; Naotaka Kushima; Satoshi Tanabe; Satoru Utsunomiya; Ryuta Sasamoto; Hidefumi Aoyama

doi:10.1016/j.ctro.2017.12.003

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

Clin Transl Radiat Oncol. 2017 Dec 24:9:12-17. doi: 10.1016/j.ctro.2017.12.003. eCollection 2018 Feb.

Affiliations

¹ Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
² Division of Radiation Oncology, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
³ Department of Radiological Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-dori, Chuo-ku, Niigata 951-8518, Japan.

Abstract

Background and purpose: 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.

Methods and materials: 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.

Results: 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).

Conclusion: CRT with low-dose continuous 5FU may be a less toxic option for elderly ESCC patients.

Keywords: 5-Fluorouracil; Chemoradiotherapy; Cisplatin; Esophageal cancer; Hematological toxicity.