Clinical outcomes of definitive chemoradiotherapy using carboplatin and paclitaxel in esophageal cancer

Abstract

Patients with nonmetastatic esophageal cancer not suitable for surgery can be treated with definitive chemoradiotherapy with curative intent. The purpose of this retrospective study is to evaluate the clinical outcomes of definitive chemoradiotherapy using carboplatin and paclitaxel. Medical records were reviewed of patients treated for nonmetastatic squamous cell or adenocarcinoma of the esophagus between January 2009 and December 2013 in two collaborating institutes. Treatment consisted of external beam radiotherapy (28 fractions of 1.8 Gy) and 6 weekly courses of carboplatin (AUC = 2) and paclitaxel (50 mg/m2). Data on survival, progression, toxicity, and effect on dysphagia were recorded. Sixty-six patients were included. Median overall survival (OS) was 13.1 months (95% CI 4.7-21.5 months) and a 2-year OS was 30% (95% CI 18%-42%). At 2 years, 26% of patients developed local progression (95% CI 15%-37%) and 49% developed distant metastases (95% CI 36%-64%). Acute toxicity grade ≥3 was observed in 47% of patients. Late adverse events grade ≥3 were seen in 20%, mostly esophageal stenoses. Of patients with available data 3 months after treatment, 70% had relief of dysphagia. Definitive chemoradiotherapy led to a median OS of 13 months. Toxicity was common, mostly due to hematological toxicity. Given the relatively short median survival, an adequate selection of patients for this intensive treatment is required.

A study of concurrent chemoradiotherapy with weekly docetaxel and cisplatin for advanced esophageal squamous cell carcinoma with T4 and/or M1 lymph node metastasis or locoregional recurrence

“…The ratio of local/regional failure and persistence of disease after 2 years in both the high-dose and standarddose arms was more than 50% in RTOG 94-05 [5]. In the present study, the locoregional control rate was 64.3% after 3 years and seemed to be similar to the studies using TC [11,30] but higher than that found in previous studies of PF. Furthermore, the initial failure pattern was so different that there were fewer patients with persistent tumors in our study.…”

“…Our results showed that the tumor response rate was 80.8%; the median OS and PFS time were 18.2 months and 11.5 months, and the 3-year OS and PFS were 36.4 and 31.5%, respectively. These results were more promising than previous similar studies of PF and TC-based CRT [9][10][11]18]. However, without a prospective randomized comparison, we can't conclude DP regimen is superior to than PF or TC regimen for locally advanced and recurrent esophageal SCC.…”

“…The regimen of paclitaxel and carboplatin (TC), which has been a standard regimen of neoadjuvant CRT for esophageal cancer [8], also has an increasing use in definitive CRT. Previous prospective and multi-center retrospective studies found the median overall survival (OS) was 12-13.8 months for inoperable patients who received concurrent CRT with TC regimen [9][10][11]. Compared with paclitaxel, docetaxel is more active as a promoter of tubulin polymerization and an inhibitor of cell replication in vitro [12].…”

CDK4/6 dual inhibitor abemaciclib demonstrates compelling preclinical activity against esophageal adenocarcinoma: a novel therapeutic option for a deadly disease

“…The extremely lethal disease has an overall 5-year survival rate of only 18.8% due to the high rate of late-stage diagnoses and lack of effective therapeutic regimens [ 2 ]. Currently, standard-of-care treatment recommendations for locally advanced esophageal cancer include neoadjuvant chemoradiotherapy followed by surgery, demonstrating only minimal benefit with regard to prognosis [ 3 , 4 ]. Therefore, significant advancements in screening strategies, risk stratification, and novel therapeutics are urgently needed to improve care and prognosis for patients.…”

Efficacy of chemo-radiotherapy versus radiotherapy alone in the treatment of esophageal carcinoma

“…Patients with esophageal carcinoma mainly present with dysphagia; however, to our knowledge limited data is available regarding its relief. In a previous study, patients receiving fluorouracil and cisplatin showed improvement from baseline to week 15 (37.6 versus 29.9, p=0.047) [25].Another retrospective study that included patients (N=66) with esophageal carcinoma and treated with chemoradiotherapy (carboplatin and paclitaxel) demonstrated that around 70% of patients had relief of dysphagia [26]. In the present study, dysphasia relief was achieved in 64% and 48% of patients from chemo-radiotherapy and radiotherapy alone group, respectively.…”