title: Phase 2 trial of induction and concurrent chemoradiotherapy with weekly irinotecan and cisplatin followed by surgery for esophageal cancer.
abstract: BACKGROUND
  Preoperative chemoradiation improves survival in esophageal and gastroesophageal junction (GEJ) cancer. We evaluated irinotecan and cisplatin as induction chemotherapy followed by concurrent chemoradiation in esophageal cancer.
  
  
  METHODS
  Patients with uT1N1M0 or uT2-4NanyM0 resectable squamous cancer or adenocarcinoma of the esophagus or GEJ received irinotecan 65 mg/m(2) and cisplatin 30 mg/m(2) for 4 treatments in weeks 1 through 5, followed by 4 treatments in weeks 7 through 11 with 50.4 Gy in daily fractions, followed by surgery. The primary endpoint was pathologic complete response (pCR). Positron emission tomography (PET) scan was performed prior to chemotherapy and as restaging prior to radiotherapy.
  
  
  RESULTS
  Fifty-five patients were evaluable, 75% of whom had adenocarcinoma and 65% of whom had uT3N1 disease. Thirty-eight patients underwent R0 resection (69%). The incidence of pCR was 16% (95% confidence interval, 8%-29%). Median overall survival was 31.7 months. An exploratory analysis of PET response to induction chemotherapy indicated a correlation with pCR (32% vs 4%), R0 resection (84% vs 57%), progression-free survival (24.1 vs 7.7 months), and overall survival (40.2 vs 25.5 months).
  
  
  CONCLUSIONS
  Weekly treatment with irinotecan, cisplatin, and radiation achieved results no better and potentially inferior to other phase 2 chemoradiotherapy trials with a low rate of pCR. The use of PET scan after induction chemotherapy to direct chemotherapy during subsequent radiotherapy merits further study.
authors: Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. ilsond@mskcc.org
authors: David H
authors: DH
authors: Ilson
authors: Bruce D
authors: BD
authors: Minsky
authors: Geoffrey Y
authors: GY
authors: Ku
authors: Valerie
authors: V
authors: Rusch
authors: Nabil
authors: N
authors: Rizk
authors: Manish
authors: M
authors: Shah
authors: David P
authors: DP
authors: Kelsen
authors: Marinela
authors: M
authors: Capanu
authors: Laura
authors: L
authors: Tang
authors: Jenny
authors: J
authors: Campbell
authors: Manjit
authors: M
authors: Bains
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D000077146:Irinotecan; D008297:Male; D008875:Middle Aged; D018307:Neoplasms, Squamous Cell / Q000628:therapy*; D049268:Positron-Emission Tomography
chemical_list: D000077146:Irinotecan; D002945:Cisplatin; D002166:Camptothecin