Top Line: A couple of years ago, a Chinese prospective randomized trial found that the oral chemotherapy, S-1, improved overall survival when added to conventional radiation alone for older patients with unresectable esophageal squamous cell carcinoma.
The Study: The new twist here is the incorporation of more modern radiation techniques where both arms receive definitive radiation via IMRT using a simultaneous integrated boost to gross tumor of 59.92 Gy over 28 fractions with a traditional planning target volume receiving 50.4 Gy over the same period. 330 patients 70 years and older receiving this treatment were randomized to +/- the addition of oral S-1 fluorouracil-based chemo concurrent to and following radiation. Once again, overall survival was significantly improved with the addition of S-1 at both one (62% → 72%) and three (34% → 46%) years. What’s more, there was no difference in grade 3+ toxicity. A final note is that grade 5 events weren’t unheard of, with five occurring in each arm related to pneumonitis or complications of low blood counts.
TBL: Oral S-1 improves survival when added to modern definitive radiation for ESCC in older patients of eligible populations. | Wang, JAMA Netw Open 2023
The Study: The new twist here is the incorporation of more modern radiation techniques where both arms receive definitive radiation via IMRT using a simultaneous integrated boost to gross tumor of 59.92 Gy over 28 fractions with a traditional planning target volume receiving 50.4 Gy over the same period. 330 patients 70 years and older receiving this treatment were randomized to +/- the addition of oral S-1 fluorouracil-based chemo concurrent to and following radiation. Once again, overall survival was significantly improved with the addition of S-1 at both one (62% → 72%) and three (34% → 46%) years. What’s more, there was no difference in grade 3+ toxicity. A final note is that grade 5 events weren’t unheard of, with five occurring in each arm related to pneumonitis or complications of low blood counts.
TBL: Oral S-1 improves survival when added to modern definitive radiation for ESCC in older patients of eligible populations. | Wang, JAMA Netw Open 2023