title: Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction.
abstract: BACKGROUND
  Patients with localized esophageal carcinoma often develop locoregional and distant disease recurrence. The current study investigated the outcome of a new chemotherapy combination as induction therapy before chemoradiotherapy.
  
  
  METHODS
  Forty-three patients with resectable carcinoma of the esophagus or gastroesophageal junction were enrolled. Most of the tumors were endoscopic ultrasonography (EUS) (EUS)T3 (84%) and (EUS)N1 (63%). The patients received < or = 2 6-week cycles of CPT-11 and cisplatin followed by chemoradiotherapy (45 grays with 5-fluorouracil and paclitaxel). Five to six weeks after chemoradiotherapy, the patients underwent staging and surgery. The feasibility, curative resection rates, overall and disease-free survival rates, rate of significant pathologic response, and patterns of disease recurrence were assessed.
  
  
  RESULTS
  Of the 43 patients, 39 (91%) underwent an R0 resection. Two patients (5%) died after surgery. A pathologic complete response (pathCR) was observed in 11 (28%) of the 39 patients (or 26% of the 43 patients). In addition, 16 patients (41% of 39 patients or 37% of 43 patients) had < 10% viable tumor in the surgical specimen (pathPR). A comparison of endoscopic ultrasonograpy T and N classifications with surgical T and N classifications demonstrated significant down-staging (P < 0.01). The median survival period of all 43 patients was 22.1 months. Patients who had achieved a pathCR or pathPR had a longer median survival (25.6 months) than those who achieved less than a pathPR (18.5 months; P = 0.52). None of the clinical parameters examined were found to correlate with survival or pathologic response.
  
  
  CONCLUSIONS
  CPT-11-based induction chemotherapy resulted in substantial pathCR and pathPR rates, both of which lead to a favorable survival outcome. The three-step strategy needs to be developed further, with the investigation of targeted therapies with chemotherapy and radiotherapy.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. jajani@mdanderson.org
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Garrett
authors.initials: G
authors.lastname: Walsh
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Jeff
authors.initials: J
authors.lastname: Morris
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Lynch
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
authors.forename: Roy
authors.initials: R
authors.lastname: Smythe
authors.forename: Ara
authors.initials: A
authors.lastname: Vaporciyan
authors.forename: Josephine
authors.initials: J
authors.lastname: Faust
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Cohen
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nivers
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011300:Preoperative Care; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate
chemical_list: D000077146:Irinotecan; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil; D002166:Camptothecin