Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus

Citation
Ei. Heath et al., Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus, J CL ONCOL, 18(4), 2000, pp. 868-876
Citations number
18
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Oncology,"Onconogenesis & Cancer Research
Journal title
JOURNAL OF CLINICAL ONCOLOGY
ISSN journal
0732-183X → ACNP
Volume
18
Issue
4
Year of publication
2000
Pages
868 - 876
Database
ISI
SICI code
0732-183X(200002)18:4<868:PIEOPC>2.0.ZU;2-W
Abstract
Purpose: This phase II trial evaluated continuous-infusion cisplatin and fl uorouracil (5-FU) with radiotherapy followed by esophagectomy. The objectiv es of this trial were to determine the complete pathologic response rate, s urvival rate, toxicity, pattern of failure, and feasibility of administerin g adjuvant chemotherapy in patients with resectable cancer of the esophagus treated with preoperative chemoradiation. Patients and Methods: Patients were staged using computed tomography, endos copic ultrasound, and laparoscopy. The preoperative treatment plan consiste d of continuous intravenous infusion of cisplatin and 5-FU and a total dose of 44 Gy of radiation. Esophagogastrectomy was planned for approximately 4 weeks after the completion of chemoradiotherapy. Paclitaxel and cisplatin were administered as postoperative adjuvant therapy. Results: Forty-two patients were enrolled onto the trial. Of the 39 patient s who proceeded to surgery, 29 responded to preoperative treatment: 11 achi eved pathologic complete response (CR) and 18 achieved a lower posttreatmen t stage. Five patients had no change in stage, whereas eight had progressiv e disease (four with distant metastases and four with increases in the T an d N stages). At a median follow-up of 30.2 months, the median survival time has not been reached and the P-year survival rate is 62%, The median survi val of pathologic complete responders has not been reached, whereas the a-y ear survival rate of this group is 91% compared with 51% in patients with c omplete tumor resection with residual tumor (P = .03). Conclusion: An excellent survival rate, comparable to that of our prior pre operative trial, was achieved with lower doses of preoperative cisplatin an d 5-FU concurrent with radiotherapy (C) 2000 by American Society of Clinica l Oncology.