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. 2022 Jul 11;29(7):4868-4878.
doi: 10.3390/curroncol29070386.

Regional Chemotherapy Is a Valuable Second-Line Approach in Metastatic Esophageal Cancer after Failure to First-Line Palliative Treatment

Yogesh Vashist  1 , Kornelia Aigner  2 , Miriam Dam  1 , Sabine Gailhofer  1 , Karl R Aigner  1
Affiliations

Regional Chemotherapy Is a Valuable Second-Line Approach in Metastatic Esophageal Cancer after Failure to First-Line Palliative Treatment

Yogesh Vashist et al. Curr Oncol. .

Abstract

Background: Therapeutic options in metastatic esophageal cancer (EC) are limited with unsatisfactory results. We evaluated the efficacy of regional chemotherapy (RegCTx) approach in diffuse metastatic EC using arterial infusion (AI), upper abdominal perfusion (UAP) and isolated-thoracic perfusion (ITP) in 14 patients (N = 8 adenocarcinoma (AC) and N = 6 squamous cell carcinoma (SQCC)) after failure to first-line palliative treatment.

Methods: All patients had previously failed first-line palliative treatment attempt with systemic chemotherapy (sCTx). In total 51 RegCTx cycles (12 AI, 3 UAP and 36 ITP) were applied using cisplatin, Adriamycin and Mitomycin C. The outcome was evaluated using RECIST criteria with MediasStat 28.5.14 and SPSS-28.0.

Results: No grade III or IV hematological complications occurred. The overall response rate was 41% partial response, 27% stable and 32% progressive disease. Median overall survival (OS) was 38 months (95%CI 10.1-65.9). The OS was better in SQCC with 51 months The RegCTx specific survival was 13 months (95%CI 2.9-23.1) in the entire cohort and 25 months in SQCC patients.

Conclusion: RegCTx is a valuable safe approach and superior to the current proposed therapeutic options in metastatic EC after failure to first-line therapy.

Keywords: arterial infusion; esophageal cancer; isolated thoracic perfusion; regional chemotherapy; second-line therapy; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The intraoperative pictures demonstrate (A) placement of balloon catheter and level of blockage in the inferior cava vein and aorta; (B) blood flow stop below the right atrium from downwards and depiction of inferior cava vein and hepatic veins; (C) blood flow stop below the inflated balloon catheter in the aorta and depiction of covering entire thoracic aorta with pulsatile injections.
Figure 2
Figure 2
Cycle stratified response to regional chemotherapy. PR and SD are more common during the earlier cycles compared to PD which is more frequent at later cycles. The best response appears after the third cycle.
Figure 3
Figure 3
Cumulative overall survival in the entire cohort of 14 patients.
Figure 4
Figure 4
Cumulative regional chemotherapy specific survival in the entire cohort of 14 patients.
See this image and copyright information in PMC

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