Clinical Outcome in Definitive Concurrent Chemoradiation With Weekly Paclitaxel and Carboplatin for Locally Advanced Esophageal and Junctional Cancer

Abstract

There are little data on the efficacy and safety of taxane/platinum with definitive radiotherapy (RT) for esophageal/GEJ cancer. This article is a retrospective analysis of patients who received weekly paclitaxel 50 mg/m(2) and carboplatin AUC 2 with radical definitive RT for locally advanced esophageal/GEJ cancer. Between February 2011 and July 2014, 179 patients were included. The median age was 54 years. Ninety-two percent of patients had squamous histology. Mean RT dose was 58.7 Gy in 32 fractions over 53 days, with mean of six chemotherapy cycles. Fifty-six percent of patients developed ≥grade 3 acute toxicities, commonly febrile neutropenia (12%) and infection (11%); ≥grade 3 laboratory abnormalities included hyponatremia (38%), leukopenia (49%), neutropenia (27%), and anemia (16%). Twelve percent of patients developed ≥grade 3 chronic toxicity. Fatal toxicities included six during CRT, eight within 30 days of completing CRT, and three chronic. Radiologic response was 49% (CR 5.6%, PR 43%). Follow-up endoscopy showed remission in 53% and residual disease in 14%. At a median follow-up of 28 months, median PFS was 11 months (95% CI: 8-13.9), median OS was 19 months (95% CI: 15.4-22.6), and estimated 1-year, 2-year, and 3-year survivals were 70%, 47%, and 39%, respectively. Weekly paclitaxel-carboplatin concurrently with definitive RT is efficacious with manageable toxicity. [The trial was registered with the Clinical Trials Registry-India (CTRI), registration number: CTRI/2014/07/004776.].

Preoperative serum sodium level as a prognostic and predictive biomarker for adjuvant therapy in esophageal cancer

“…Hyponatremia occurred at a relative high frequency (16-59%) in EC patients who previously received chemotherapy [17][18][19][20][21][22]. However, we found that the incidence of hyponatremia in treatment-naïve EC patients was only 2%.…”

“…The incidence and prognostic value of hyponatremia in EC patients remains underestimated yet. In previous studies, hyponatremia occurred as an adverse event in 16% − 59% of EC patients who had received chemotherapy or chemoradiation [17][18][19][20][21][22]. However, hyponatremia induced by chemotherapy seemed not to be correlated with outcome of patients with EC [21].…”

Definite intensity‐modulated radiotherapy with concurrent chemotherapy more than 4 cycles improved survival for patients with locally‐advanced or inoperable esophageal squamous cell carcinoma

“…Combination of concurrent chemotherapy with taxane and platinum showed better tumor response in either adenocarcinoma or squamous cell carcinoma of the esophagus with acceptable toxicities [7,8,27,28]. If surgery is planned as a component of treatment, this regimen combined with reduction of neoadjuvant radiation does is feasible [7,8].…”

“…In the current study, we found that patients who had a radiation dose of >50.4 Gy and chemotherapy <4 cycles had the worst survival. Possible reasons for this result Combination of concurrent chemotherapy with taxane and platinum showed better tumor response in either adenocarcinoma or squamous cell carcinoma of the esophagus with acceptable toxicities [7,8,27,28]. If surgery is planned as a component of treatment, this regimen combined with reduction of neoadjuvant radiation does is feasible [7,8].…”

SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016)

“…For a patient unable to undergo surgery, but able to tolerate chemotherapy plus radiotherapy, different regimens based on Oxaliplatin/Fluoropyrimidine [24] or carboplatin/paclitaxel [26] combinations may be an alternative to “classical” Cisplatin/5-fluorouracil schedule, due to their favorable toxicity profile (E:moderate; R: strong). If a patient is unable to tolerate combined therapy, chemotherapy alone is an option.…”