title: Safety, efficacy, and long-term follow-up evaluation of perioperative epirubicin, Cisplatin, and capecitabine chemotherapy in esophageal resection for adenocarcinoma.
abstract: BACKGROUND
  Perioperative epirubicin, cisplatin, and capecitabine (ECC) chemotherapy was evaluated in patients who underwent esophageal resection for adenocarcinoma of the esophagus or gastroesophageal junction (GEJ).
  
  
  METHODS
  A cohort of 93 consecutive patients was analyzed. The median follow-up period was 60 months. Source data verification of adverse events was performed by two independent observers.
  
  
  RESULTS
  All three planned preoperative chemotherapy cycles were administered to 65 patients (69.9 %). Only 27 % of the patients completed both pre- and postoperative chemotherapy. The reasons for not receiving postoperative adjuvant chemotherapy could be separated in two main problems: toxicity of the preoperative chemotherapy and postoperative problems involving difficulty in recovery and postoperative complications. Finally, 25 patients (27 %), completed three preoperative and three postoperative cycles. Grades 3 and 4 nonhematologic adverse events of preoperative chemotherapy mainly consisted of thromboembolic events (16.2 %) and cardiac complications (7.5 %). A history of cardiac and vascular disease was independently associated with discontinuation of preoperative chemotherapy and the occurrence of grade 3 or higher adverse events. Surgery was performed for 94 % of all the patients who started with ECC chemotherapy. A radical resection (R0) was achieved in 93 % of the patients. A complete pathologic response was observed in 8 % of the patients. During a median follow-up period of 60 months, the median disease-free survival time was 28 months, and the median overall survival time was 36 months. The 3-year overall survival rate was 50 %, and the 5-year overall survival rate was 42 %.
  
  
  CONCLUSIONS
  For patients with adenocarcinoma of the esophagus or GEJ, six cycles of ECC-based perioperative chemotherapy is associated with a relatively high number of adverse events. Although this toxicity did not affect the esophageal resectability rate, this regimen should be used with caution in this patient population.
authors.affiliation: Department of Surgery, G04.228, University Medical Center Utrecht, Utrecht, The Netherlands, P.C.vanderSluis-2@umcutrecht.nl.
authors.forename: P C
authors.initials: PC
authors.lastname: van der Sluis
authors.forename: I
authors.initials: I
authors.lastname: Ubink
authors.forename: S
authors.initials: S
authors.lastname: van der Horst
authors.forename: J J
authors.initials: JJ
authors.lastname: Boonstra
authors.forename: E E
authors.initials: EE
authors.lastname: Voest
authors.forename: J P
authors.initials: JP
authors.lastname: Ruurda
authors.forename: I H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.forename: M J
authors.initials: MJ
authors.lastname: Wiezer
authors.forename: M E I
authors.initials: ME
authors.lastname: Schipper
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.forename: M
authors.initials: M
authors.lastname: Los
authors.forename: M P
authors.initials: MP
authors.lastname: Lolkema
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D004943:Esophagogastric Junction / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D019990:Perioperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012449:Safety; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015251:Epirubicin; D000069287:Capecitabine; D002945:Cisplatin