Concurrent Erlotinib And Radiotherapy For Elderly Squamous Cell Esophageal Carcinoma: Results Of A Pilot Study

Concurrent chemoradiotherapy is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC), but at the expense of increased toxicities. However, quite a few patients cannot endure chemoradiotherapy due to their old age or malnutrition. Erlotinib, an inhibitor of epidermal growth factor receptor tyrosine kinase, was effective in treating ESCC with mild toxicities. This pilot study is to investigate the feasibility and efficacy of concurrent erlotinib and radiotherapy for elderly ESCC. Between December 2007 and August 2010, eighteen pathologically diagnosed ESCC patients were enrolled in the study. The median age was 71.5 years. The disease was stage II, III and IV in 4, 10 and 4 patients, respectively. Seven patients received surgery before, including 3 with post-operative local-regional recurrence. All patients were treated with concurrent erlotinib and intensity-modulated radiation therapy. Erlotinib was given orally 150mg/d for at least 8 weeks. Radiotherapy was given by 2 Gy per day, 5 days per week to a total dose of 46 to 70 Gy. The overall survival (OS), progression free survival (PFS) and local-regional free survival (LRFS) were calculated using the Kaplan-Meier method. Toxicities were evaluated according to the NCI-CTC 3.0. At one month post-radiotherapy, there were 2 (11.1%) complete response, 8 (44.4%) partial response and 5 (27.8%) stable disease. With a median follow up of 26.1 months, 14 patients (77.8%) achieved local control. The median recurrence-free time was reached. Four patients died of distant metastasis and 3 died of local progression. The median time of OS, PFS and LRFS was 28.7, 12 and 12 months, respectively. Grade 3 esophagitis was observed in 5 patients (27.8%), grade 3 skin rash in 2 patients (11.1%). Radiation pneumonitis of grade 2 and 4 was observed in one each. There is no grade 3/4 impaired liver function or hematological toxicities. Concurrent erlotinib and radiotherapy is effective and tolerable in elderly ESCC patients who are unfit for concurrent chemoradiotherapy. Prospective trial is necessary to confirm the efficacy and feasibility.