title: Cisplatin- vs. oxaliplatin-based radiosensitizing chemotherapy for squamous cell carcinoma of the esophagus: a comparison of two preoperative radiochemotherapy regimens.
abstract: OBJECTIVE
  To compare the outcomes of two neoadjuvant radiochemotherapy (N-RCT) regimens for squamous cell carcinoma of the esophagus (ESCC).
  
  
  METHODS
  The standard N-RCT regimen for ESCC at our institution between 2002 and 2011 was a total dose of 45 Gy (1.8-Gy fractions) with concomitant cisplatin (20 mg/m(2), days 1-5 and 29-33) and 5-fluorouracil (5-FU; 225 mg/m(2), 24 h continuous infusion on days 1-33). During the same period, a phase I/II study comparing the standard ESCC N-RCT protocol with a regimen identical except for the replacement of cisplatin with weekly oxaliplatin (40-50 mg/m(2)) was performed at our center. The standard regimen was used to treat 40 patients; 37 received the oxaliplatin regimen. All patients subsequently underwent radical resection with reconstruction according to tumor location and two-field lymph node dissection.
  
  
  RESULTS
  Median follow-up time from the start of N-RCT was 74 months (range 3-116 months). The two patient groups were comparable in terms of demographic and baseline tumor characteristics. R0 resection was achieved in 37/39 patients (95 %) in the cisplatin-based N-RCT group, compared to 24/37 (65 %) in the oxaliplatin-based group (p = 0.002). A pathological complete response (pCR) was seen in the resection specimens from 18/39 patients (46 %) in the cisplatin-based N-RCT group and in 8/37 (22 %) oxaliplatin-group patients. In the cisplatin group, 2- and 5-year overall survival (OS) rates were 67 ± 8 % and 60 ± 8 %, respectively (median OS 103 months), compared to 38 ± 8 % and 32 ± 8 %, respectively, for the oxaliplatin group (median OS 17 months; hazard ratio, HR 0.452; 95 % confidence interval, CI 0.244-0.839; p = 0.012).
  
  
  CONCLUSIONS
  Oxaliplatin-based N-RCT resulted in poorer outcomes in ESCC patients and should not routinely replace cisplatin-based N-RCT.
authors.affiliation: Department of Radiation Oncology, Marien Hospital Herne, University Clinic of the Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, Germany, khfmed@yahoo.com.
authors.forename: K
authors.initials: K
authors.lastname: Fakhrian
authors.forename: A D
authors.initials: AD
authors.lastname: Ordu
authors.forename: B
authors.initials: B
authors.lastname: Haller
authors.forename: J
authors.initials: J
authors.lastname: Theisen
authors.forename: F
authors.initials: F
authors.lastname: Lordick
authors.forename: V
authors.initials: V
authors.lastname: Bišof
authors.forename: M
authors.initials: M
authors.lastname: Molls
authors.forename: H
authors.initials: H
authors.lastname: Geinitz
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects* / Q000379:methods*; D002945:Cisplatin / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000627:therapeutic use*; D000077150:Oxaliplatin; D011300:Preoperative Care / Q000379:methods; D017564:Radiation Pneumonitis / Q000175:diagnosis / Q000209:etiology*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D011838:Radiation-Sensitizing Agents; D000077150:Oxaliplatin; D002945:Cisplatin
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