title: Analysis of pathological complete response rates with paclitaxel-based regimens in trimodality therapy for esophageal cancer.
abstract: The study aimed to examine whether omission of 5-fluorouracil (5-FU)-containing chemotherapy alters pathological complete response rates in patients receiving trimodality therapy for locally advanced esophageal cancer. A total of 159 patients were identified. One hundred twenty-nine patients received platinum/5-FU concurrently with radiotherapy, and 30 received taxane/platinum-containing chemoradiotherapy prior to esophagectomy. Patients were staged using the 2002 American Joint Committee on Cancer staging system. Patients were matched between chemotherapeutic groups, with no significant demographic or clinical differences other than T stage (14% T2 in the 5-FU group; no T2 in the platinum/taxane group) and radiotherapy technique (8.5% received intensity-modulated radiotherapy in the 5-FU group; 60% in the platinum/taxane group). Pathological complete response rates for 5-FU and platinum/taxane-based groups were not significantly different (45% and 30%, respectively; P = 0.1548). Five-year overall survival and progression-free survival were not statistically different between the two groups. Significant predictors of pathological complete response included N stage (56% N0 and 33% N1; P = 0.0083), histology (37% adenocarcinoma and 59% squamous cell; P = 0.0123), tumor location (39% distal and 59% proximal/mid; P = 0.048), gastroesophageal junction involvement (33% involved and 55% uninvolved; P = 0.005), and radiotherapy end-to-surgery interval (50% < 55 days and 34% ≥ 55 days; P = 0.04). Grades 3-4 hematological toxicity was higher in the 5-FU group (36%) than in the paclitaxel-containing therapy group (17%; P = 0.0484). Use of paclitaxel-containing chemoradiotherapy did not result in inferior pathological complete response, overall survival, or progression-free survival rates, and resulted in less hematological toxicity than 5-FU treatment.
authors.affiliation: Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Boggs
authors.affiliation: Department of Medical Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: C
authors.initials: C
authors.lastname: Tarabolous
authors.affiliation: Department of Biostatistics, University of Florida, Gainesville, FL, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Morris
authors.affiliation: University of Maryland Medical School, Baltimore, MD, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hanna
authors.affiliation: Department of Thoracic Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: W
authors.initials: W
authors.lastname: Burrows
authors.affiliation: Department of Medical Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: N
authors.initials: N
authors.lastname: Horiba
authors.affiliation: Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Suntharalingam
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D024221:Antineoplastic Protocols; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000379:methods / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000379:methods* / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000627:therapeutic use*; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D043823:Taxoids / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane; D017239:Paclitaxel; D005472:Fluorouracil
keywords: chemotherapy; esophageal cancer; pathological complete response; trimodality