Neoadjuvant concurrent chemoradiation with weekly paclitaxel and carboplatin for patients with oesophageal cancer: a phase II study

Abstract

This study was performed to assess the efficacy and safety of preoperative chemoradiation consisting of carboplatin and paclitaxel and concurrent radiotherapy for patients with resectable (T2-3N0-1M0) oesophageal cancer. Treatment consisted of paclitaxel 50 mg m À2 and carboplatin AUC ¼ 2 on days 1, 8, 15, 22 and 29 and concurrent radiotherapy (41.4 Gy in 23 fractions, 5 days per week), followed by oesophagectomy. All 54 entered patients completed the chemoradiation without delay or dose-reduction. Grade 3 -4 toxicities were: neutropaenia 15%, thrombocytopaenia 2%, and oesophagitis 7.5%. After completion of the chemoradiotherapy 63% had a major endoscopical response. Fifty-two patients (96%) underwent a resection. The postoperative mortality rate was 7.7%. All patients had an R0-resection. The pathological complete response rate was 25%, and an additional 36.5% had less than 10% vital residual tumour cells. At a median follow-up of 23.2 months, the median survival time has not yet been reached. The probability of disease-free survival after 30 months was 60%. In conclusion, weekly neoadjuvant paclitaxel and carboplatin with concurrent radiotherapy is a very tolerable regimen and can be given on an outpatient basis. It achieves considerable down staging and a subsequent 100% radical resection rate in this series. A phase III trial with this regimen is now ongoing.

Effect of extending the original eligibility criteria for the “CROSS” neoadjuvant chemoradiotherapy on toxicity and survival in esophageal cancer.

“…The incidences of severe leukopenia (grade C 3) in group 1 (15.7%) and group 2 (16.7%) were somewhat higher than the 6% in the original CROSS trial but within the range of 3-24% in the literature. 1,8,9 Furthermore, the observed rates of thrombocytopenia grade 3 or higher of 1.1% in group 1 and 0% in group 2 correspond well with the 1% rate of thrombocytopenia in the CROSS trial. The 30-day mortality rates in group 1 (2.2%) and group 2 (4.2%) are also comparable …”

Esophageal and Esophagogastric Junction Cancers

“…[147][148][149][150][151][152][153][154][155][156][157][158][159][160][161][162][163] In a recent phase I/II study, preoperative chemoradiation with a three drug regimen comprising of docetaxel, oxaliplatin, and capecitabine was safe and effective in patients with locoregional disease. 164 At a median follow-up of 116 weeks, median disease-free and overall survivals were 16 and 24 months, respectively.…”

Value of Bronchoscopy after EUS in the Preoperative Assessment of Patients with Esophageal Cancer at or Above the Carina

“…Despite many improvements in diagnostic and therapeutic strategies, the prognosis is still unfavorable. [1][2][3][4] The proximal part of the intrathoracic esophagus is located between the trachea and the vertebral column. Therefore, esophageal tumors at or above the carina tend to invade the tracheobronchial tree, precluding curative surgery.…”