Concurrent chemoradiotherapy with twice weekly paclitaxel and cisplatin followed by esophagectomy for locally advanced esophageal cancer.
BACKGROUND
To test the feasibility of incorporating a twice-weekly paclitaxel (Taxol) and cisplatin regimen into concurrent chemoradiotherapy (CCRT), followed by surgery, for patients with locally advanced esophageal cancer.


METHODS
Patients with operable T3N0-1M0 or T1-3N1M0 esophageal cancer were enrolled. The CCRT regimen included paclitaxel (35 mg/m2 1 h on days 1 and 4/week), cisplatin (15 mg/m2 1 h on days 2 and 5/week), and radiotherapy (2 Gy on days 1-5/week). When the accumulated radiation dose reached 40 Gy, the feasibility of esophagectomy was evaluated in all patients. In patients for whom esophagectomy was not feasible, CCRT was continued to a dose of 60 Gy.


RESULTS
The majority of 97 patients enrolled had squamous cell carcinoma on histology (95%) and T3N1 disease by endoscopic ultrasonographic staging (90%). All patients received CCRT to 40 Gy. Sixty-one patients underwent surgery, and 26 patients continued definitive CCRT to 60 Gy. The intention-to-treat pathological complete response rate was 25% [24/97, 95% confidence interval (CI) 16-33]. At a median follow-up of 25.3 months, the median progression-free and overall survival was 15.6 and 28.8 months, respectively. The most common grade 3/4 toxic effects were leukopenia (30%), thrombocytopenia (10%), and diarrhea (15%).


CONCLUSIONS
CCRT with a twice-weekly paclitaxel and cisplatin regimen followed by esophagectomy is an active treatment of locally advanced esophageal cancer.
Lin
C-C
CC
Department of Oncology, National Taiwan University Hospital; Cancer Research Center, National Taiwan University College of Medicine.
Hsu
C-H
CH
Department of Oncology, National Taiwan University Hospital; Cancer Research Center, National Taiwan University College of Medicine.
Cheng
J C
JC
Department of Oncology, National Taiwan University Hospital.
Wang
H-P
HP
Department of Emergency Medicine.
Lee
J-M
JM
Department of Surgery.
Yeh
K-H
KH
Department of Oncology, National Taiwan University Hospital; Cancer Research Center, National Taiwan University College of Medicine; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yang
C-H
CH
Department of Oncology, National Taiwan University Hospital; Cancer Research Center, National Taiwan University College of Medicine.
Lin
J-T
JT
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Cheng
A-L
AL
Department of Oncology, National Taiwan University Hospital; Cancer Research Center, National Taiwan University College of Medicine; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: andrew@ha.mc.ntu.edu.tw.
Lee
Y-C
YC
Department of Surgery. Electronic address: wuj@ha.mc.ntu.edu.tw.
D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
D002945:Cisplatin; D005472:Fluorouracil