title: Toxicity data for preoperative concurrent chemoradiotherapy with oxaliplatin and continuous infusion 5-fluorouracil for locally advanced esophageal cancer.
abstract: The purpose of this retrospective analysis was to characterize the feasibility and tolerability of oxaliplatin/5-fluorouracil (5-FU) given concurrently with radiotherapy for patients with locally advanced esophageal cancer. Between July 2005 and March 2009, 15 patients with clinical stage T3/T4 and/or N1/M1a lower esophageal or gastroesophageal junction adenocarcinoma were treated with preoperative chemoradiotherapy using oxaliplatin every 2 weeks and continuous infusion 5-FU. The main treatment-related toxicities were oral mucositis and dysphagia. During the first 2 weeks of treatment, 20% of patients presented with grade 1-2 oral mucositis, and one patient developed grade 1 dysphagia. In weeks 3-4, 53% of the patients experienced grade 1-2 mucositis, and 40% experienced grade 1-2 dysphagia. One patient only experienced grade 3 mucositis in week 4. Three patients (20%) had grade 3-4 dysphagia in weeks 3-4 and were continued on intravenous fluids and pain medications. During the last 2 weeks of chemoradiotherapy, 53% of patients reported grade 1-2 oral mucositis, mostly grade 1 and 73% of patients experienced grade 1-2 dysphagia and 26% patients experienced grade 3-4 dysphagia. Other toxicities included fatigue, nausea, neuropathy, and diarrhea. Only one patient experienced > 10% weight loss. The whole group was treated with aggressive supportive care during radiotherapy. Five (33%) patients achieved a pathological complete response. No patients developed locoregional failure. Sixty percent of the patients developed distant metastases and the 2-year disease-free survival was 53%. The median survival was 3.2 years with the 2-year overall survival of 73%. Preoperative oxaliplatin/5-FU-based chemoradiotherapy for locally advanced esophageal cancer is feasible, but associated with substantial gastrointestinal toxicity. A careful attention to nutrition and hydration throughout the course of therapy is required.
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Thukral
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Metz
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: W-T
authors.initials: WT
authors.lastname: Hwang
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: P
authors.initials: P
authors.lastname: O'Dwyer
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Plastaras
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: S
authors.initials: S
authors.lastname: Both
authors.affiliation: Department of Radiation OncologyDepartment of Biostatistics and EpidemiologyDepartment of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
authors.forename: V
authors.initials: V
authors.lastname: Bar-Ad
authors.forename: V Bar
authors.initials: VB
authors.lastname: Ad
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods; D003680:Deglutition Disorders / Q000139:chemically induced*; D003967:Diarrhea / Q000139:chemically induced; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D004943:Esophagogastric Junction; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D000077150:Oxaliplatin; D057234:Preoperative Period; D012189:Retrospective Studies; D013280:Stomatitis / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil