Faculty Collaboration Database

Trimodality therapy without a platinum compound for localized carcinoma of the esophagus and gastroesophageal junction. Cancer 2010 Apr 01;116(7):1656-63

Date

02/10/2010

Pubmed ID

20143431

DOI

10.1002/cncr.24935

Scopus ID

2-s2.0-77950244862 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

BACKGROUND: : The use of platinum-based chemoradiation for esophageal cancer is routine, but it is unclear which class of cytotoxic are optimum. It was hypothesized that chemoradiotherapy with fluoropyrimidine, taxane, and camptothecin would have preserved or improved efficacy with no compromise in safety.

METHODS: : Patients with histologically confirmed, resectable esophageal carcinoma were eligible. In addition to other tests, a baseline endoscopic ultrasonography (EUS) was obtained. Patients were medically fit and had near-normal organ functions. Patients received docetaxel and irinotecan, plus 5-fluorouracil as induction therapy and then the same cytotoxics with 50.4 grays of radiotherapy followed by an attempted surgery. Pathologic complete response (pathCR) at a rate of > or =20% was the primary endpoint. The pathCR and R0 resection were correlated with overall survival (OS). Safety was documented.

RESULTS: : Fifty-five patients were enrolled. Seven were women, and the median age was 56 years. Fifty-three (96%) patients had EUST3, and 41 (75%) had EUSN1 disease. Forty-three (78%) patients underwent surgery, 20% achieved a pathCR, and 76.4% underwent an R0 resection. The median survival (n = 55 patients) was 43.3 months (range, 19-75 months). Baseline clinical parameters were not found to be predictive of OS; however, patients with a pathCR (P = .005) and who underwent R0 resection (P < or = .0001) had an improved OS. There was 1 treatment-related postsurgical death reported. Grade 3 or 4 toxicity (graded according to the National Cancer Institute Common Toxicity Criteria [version 2.0]) was observed in 62% of patients.

CONCLUSIONS: : The results of the current study documented that this 3-drug, noncisplatin-based chemoradiotherapy was feasible, safe, and active but not better than the published cisplatin-based chemoradiotherapy. A fluoropyrimidine and another cytotoxic (from any class) may be adequate to establish a baseline chemoradiotherapy regimen to combine biologics. Cancer 2010. (c) 2010 American Cancer Society.

Author List

Ajani JA, Correa AM, Walsh GL, Komaki R, Lee JH, Vaporciyan AA, Rice DC, Yao JC, Maru DM, Hofstetter WL, Phan AT, Swisher SG

Author

Alexandria T. Phan MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Carcinoma, Squamous Cell
Chemotherapy, Adjuvant
Combined Modality Therapy
Drug Administration Schedule
Esophageal Neoplasms
Esophagogastric Junction
Female
Humans
Male
Middle Aged
Platinum Compounds
Preoperative Care
Radiotherapy, Adjuvant