MCQs on “Sequential chemotherapy after definitive radiotherapy in markedly elderly patients with advanced esophageal cancer”
HS Darling1, Pradeep Jaiswal2, Nishant R Tiwari3
1 Departments of Medical Oncology and Hemato-oncology, Command Hospital Air Force, Bangalore, Karnataka, India
2 Surgical Oncology, Command Hospital Air Force, Bangalore, Karnataka, India
3 Department of Internal Medicine, B. J. Govt. Medical College, Pune, Maharashtra, India
Correspondence Address:
H S Darling
Departments of Medical Oncology and Hemato-oncology, Command Hospital Air Force, Bangalore, Karnataka
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/ijc.ijc_725_22
Q 1. In the study by Watanabe et al., patients with which of the following stages of esophageal cancer were studied?
Stage IVa and IVbStage I and IIaStage III and IVaStage IIb and IIIaQ 2. Which of the following is the standard of care for patients with esophageal cancer who are nonsurgical candidates?
Sequential chemoradiationConcurrent chemoradiationChemotherapy aloneRadiotherapy aloneQ 3. In the study by Watanabe et al., which of the following endpoints showed statistically significant improvement in the intervention arm compared to the control arm?
Total progression-free survival (TPFS)Overall survival (OS)Progression-free survival out of the radiation field (OFPFS)All of the aboveQ 4. Population showing which of the following characteristics is most suitable for treatment with sequential chemoradiotherapy based on the study conducted by Watanabe et al.?
Elderly (>75 years), nonsurgical candidatesWomen, nonsurgical candidatesWomen, cancer of lower thoracic esophagusWomen, normal serum albuminQ 5. How many patients received induction chemotherapy in the study?
0%9%16%23%Q 6. The sequential chemotherapy regimen used in majority of patients in the study conducted by Watanabe et al. was
Cisplatin and 5-fluorouracilDocetaxel and cisplatinCisplatin and 5-fluorouracil followed by docetaxel and cisplatinDocetaxel, cisplatin, and 5-fluorouracilQ 7. In the study by Watanabe et al., all patients who completed the planned SCRT regimen were
More than 77 years and PS0 at the end of radiotherapyLess than 77 years and PS1–2 at the end of radiotherapyMore than 77 years and PS1–2 at the end of radiotherapyLess than 77 years and PS0 at the end of radiotherapyQ 8. The pathological type of esophageal cancer in patients in the study by Watanabe et al. was
AdenocarcinomaSquamous cell carcinoma13% adenocarcinoma and 87% squamous cell carcinoma21% adenocarcinoma and 79% squamous cell carcinomaQ 9. Find the least correct option.
In elderly patients, the use of chemotherapy is often limited due to
Age-associated decline in functional reserveIncreased rates of comorbid conditionsConcomitant medication usePoor treatment responseQ 10. Out of 40 patients in the study by Watanabe et al., patients with complete remission, partial remission, and stable disease, respectively, were
5, 33, and 20, 33, and 75, 13, and 2233, 5, and 2Answers and explanations
1 (c) Stage III and IVa
In the study conducted by Watanabe et al.,[1] patients with advanced esophageal cancer (Stage III and IVa) were included in the study population. The study focused on elderly population (>75 years age), who are less likely to tolerate concurrent chemoradiotherapy.
2 (b) Concurrent chemoradiation
In general, patients with esophageal cancer who are poor surgical candidates due to various reasons (advanced disease, unfit for surgery due to other medical comorbidities, etc.) are treated with concurrent chemoradiotherapy.[2]
3 (d) All of the above
In the study conducted by Watanabe et al.,[1] the patient with advanced esophageal cancer treated with sequential radiotherapy (treatment arm) had significant TPFS, OS, and OFPFS benefit compared to the patient who received radiotherapy alone as a treatment modality (control arm).
4 (a) Elderly (>75 years), nonsurgical candidates
The study done by Watanabe et al. focused predominantly on the elderly patients (>75 years), who have advanced esophageal cancer (Stage III and IVa). The study did show significant survival benefit (TPFS, OS, OFPFS) in elderly patients treated with sequential chemoradiotherapy compared to treatment with radiotherapy alone. No significant benefits were observed in univariate analyses comparing sex, serum albumin level, and body mass index (BMI).
5 (a) 0%
No patients received induction chemotherapy.[1]
6 (c) Cisplatin and 5-fluorouracil followed by docetaxel and cisplatin
The standard sequential chemotherapy regimen was of two courses of standard-dose cisplatin and 5-fluorouracil followed by three courses of docetaxel and cisplatin.[1]
7 (d) Less than 77 years and PS0 at the end of radiotherapy
In the present study, all patients who completed the planned SCRT regimen were under 77 and PS0 at the end of radiotherapy. This criterion may be a selection criterion to choose patients for SCRT.[1]
8 (b) Squamous cell carcinoma
The pathological type was squamous cell carcinoma in all patients.[1]
9 (d) Poor treatment response
In elderly patients, the use of chemotherapy is often limited due to age-associated decline in functional reserve, increased rates of comorbid conditions, and concomitant medication use.[1]
10 (a) 5, 33, and 2
The therapeutic effects at the end of radiotherapy were complete remission, partial remission, and stable disease in 5, 33, and 2 patients, respectively.[1]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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