title: Preoperative low-dose weekly cisplatin and continuous infusion fluorouracil plus hyperfractionated radiotherapy in stage II-III esophageal carcinoma.
abstract: BACKGROUND
  The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus.
  
  
  METHODS
  Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1-21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy.
  
  
  RESULTS
  From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3-4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4-35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04).
  
  
  CONCLUSIONS
  Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.
authors: Radiation Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain.
authors: M
authors: M
authors: Caro
authors: Medical Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Crta del Canyet, s/n, 08916, Badalona, Barcelona, Spain. afont@iconcologia.net.
authors: A
authors: http://orcid.org/0000-0003-3908-1111
authors: A
authors: Font
authors: Radiation Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain.
authors: S
authors: S
authors: Comas
authors: Department of Surgery, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain.
authors: M
authors: M
authors: Viciano
authors: Medical Oncology Service, Hospital de Mataró, C/Hospital, 31, Mataro, Spain.
authors: J
authors: J
authors: Remon
authors: Medical Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Crta del Canyet, s/n, 08916, Badalona, Barcelona, Spain.|Medical Oncology Service, Hospital 12 de Octubre, Madrid, Spain.
authors: P
authors: P
authors: Céliz
authors: PET Unit, Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga 0, L'Hospitalet de Llobregat, Spain.
authors: J
authors: J
authors: Robles
authors: Department of Pathology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain.
authors: E
authors: E
authors: Musulén
authors: Endocrinology and Nutrition Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain.
authors: M J
authors: MJ
authors: Sendrós
authors: Intensive Care Unit, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain.
authors: E
authors: E
authors: Mesalles
authors: Radiodiagnostic Service, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain.
authors: J A
authors: JA
authors: Jiménez
authors: Department of Gastroenterology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain.
authors: J
authors: J
authors: Boix
authors: Radiation Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain.
authors: A
authors: A
authors: Arellano
authors: Department of Surgery, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain.
authors: J
authors: J
authors: Fernández-Llamazares
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D049268:Positron-Emission Tomography
chemical_list: D002945:Cisplatin; D005472:Fluorouracil
keywords: Esophageal carcinoma; Fluorouracil; Radiotherapy; Weekly cisplatin