title: [Concurrent standard dose of cisplatin, paclitaxel, and radiotherapy followed by surgery in treatment of thoracic esophageal carcinoma].
abstract: OBJECTIVE
  To investigate the curative effect of incorporation of the regimen of standard dose of paclitaxel combined with cisplatin into concurrent radiotherapy as pre-operative treatment for patients with esophageal carcinoma.
  
  
  METHODS
  Twenty-six patients with primary diagnosis of esophageal carcinoma, 17 in stage II and 9 in stage III, underwent conventional fractionated radiotherapy with a total dosage of 40 Gy (2 Gy per day, 5 doses per week). Paclitaxel were given intravenously at a dose of 135 mg/m(2) for 3 h on day1 and day 22. Cisplatin was given intravenously at a dose of 20 mg/m(2) on D1-D3 and D22-24. 4 - 6 weeks after the completion of chemo-radiotherapy, left thoracic incision and transhiatal esophagectomy with anastomosis in the neck was performed. The patients were followed up for 42.28 months. Kaplan-Meier method was used to analyze the overall survival (OS) and disease-free survival (DFS), and Log-rank test was performed to assess the survival rates statistical significance among groups.
  
  
  RESULTS
  The radical resection rate was 96.15%. The pathologic response to chemoradiotherapy were grade I in 9 patients, grade II in 6 patients, and grade III in 11 patients. The pathological complete remission (PCR) rate was 42.31% (11/26). Toxicity grade 3 - 4 included leucopenia (7.69%, 2/26), thrombocytopenia (7.69%, 2/26), and radiation esophagitis (11.54%, 3/26). Surgery-related complications included anastomotic leakage (3.85%, 1/26), recurrent laryngeal nerve injury (7.69%, 2/26), and chylothorax (3.85%, 1/26). The 3- and 5-year overall survival rates were 62.96% and 54.56% respectively. The 3- and 5-year disease-free survival rates were 59.94% and 55.65% respectively. The 3-year overall survival rates of the patients with different pathologic responses were 25.40% (for those of grade I), 60% (for grade II), and 90.91% (for grade III) respectively (P < 0.05). The 5-year overall survival rates were 0 (for grade I), 60% (for grade II), and 81.82% (for grade III) respectively (P < 0.05).
  
  
  CONCLUSIONS
  Preoperative chemoradiotherapy containing full dose of paclitaxel and cisplatin increases the 5-year overall survival for the patients with postoperative pathologic response grade II and above, and does not increase the treatment-related complications.
authors.affiliation: Department of Radiotherapy, First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, China.
authors.forename: Yi-yan
authors.initials: YY
authors.lastname: Jiang
authors.forename: Shi-xiu
authors.initials: SX
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Cong-ying
authors.initials: CY
authors.lastname: Xie
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.forename: Cheng-chao
authors.initials: CC
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011878:Radiotherapy; D055815:Young Adult
chemical_list: D017239:Paclitaxel; D002945:Cisplatin