Tolerability and efficacy of concurrent chemoradiotherapy comparing carboplatin/paclitaxel versus platinum/5-FU regimen for locally advanced esophageal and esophagogastric junction cancers

Abstract

Platinum/5-fluorouracil (PF) is commonly used for chemoradiotherapy (CRT) for locally advanced esophageal and esophagogastric junction (EGJ) cancers. Weekly carboplatin and paclitaxel (CP) regimen for preoperative CRT has increased in popularity due to its potentially less toxicity. We retrospectively compared the tolerability and efficacy of these regimens. Patients with esophageal and EGJ squamous cell carcinoma (SCC) or adenocarcinoma who received CRT with curative intent were included. Safety and tolerability during CRT were evaluated using the CTCAE version 4.0. Efficacy was analyzed using pathologic complete response, disease-free survival, and overall survival. One hundred and twenty-four patients were eligible for analysis (CP = 64, PF = 60). Most patients had esophageal cancer (97%) with SCC histology (91%). Preoperative CRT was planned for 43% of patients in the CP group and 34% in the PF group (p = 0.306). The relative dose intensities of cisplatin (67.0%) and 5-fluorouracil (81.4%) were lower than those of carboplatin (86.6%) and paclitaxel (86.2%). No difference in the radiotherapy dose, hospitalization, interruption, or termination was observed between the groups. Dose reduction of chemotherapy was more frequent in the CP group (38 vs. 19%; p = 0.015). Febrile neutropenia was more frequent in the PF group (8 vs. 0%; p = 0.058). All-grade nausea/vomiting was lower in the CP group (20 vs. 38%; p = 0.032). Efficacy was comparable between both regimens. In the multivariate analysis, the CRT regimen was not a significant predictor of survival. The CP regimen had less toxicity than the PF regimen, while efficacy was comparable. A large prospective randomized study is warranted to confirm these results.

Comparison of Efficacy and Safety of Taxanes Plus Platinum and Fluorouracil Plus Platinum in the First-Line Treatment of Esophageal Cancer: A Systematic Review and Meta-Analysis

“…Through preliminary inspection, a total of 1300 relevant studies were obtained, including 1298 which met the inclusion criteria and 2 similar reading articles. After further screening, 34 articles were obtained for further evaluation [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Among these studies, the chemotherapy regimen of one and the study objects of two did not meet the inclusion criteria.…”

“…Among these studies, the chemotherapy regimen of one and the study objects of two did not meet the inclusion criteria. Finally, a total of 31 articles involving 3432 participants were included [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The detailed retrieval process of this review is shown in Figure 1 .…”

Neoadjuvant Carboplatin/Paclitaxel versus 5-Fluorouracil/Cisplatin in Combination with Radiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A Multicenter Comparative Study

“…The relatively low toxicity profile of the CROSS regimen compared to PF while maintaining the same efficacy has made CROSS widely popular as nCRT in Western regions, mainly in response to esophageal adenocarcinoma [ 10 , 11 , 12 ]. While the subset of patients with ESCC in the CROSS trial showed promising findings (i.e., pathologically complete response [pCR] rate = 49%; median survival = 81.6 months), replication of these findings in Asia has not been successful [ 13 , 14 , 15 ].…”

Impact of Weight Loss on Patients with Locally Advanced Esophageal and Esophagogastric Junction Cancers Treated with Chemoradiotherapy

“…The squamous cell carcinoma subtype accounts for approximately 90% of all esophageal cancers worldwide, and in Thailand. (Torre et al, 2015;Tamtai et al, 2017). The survival rates of most patients diagnosed with locally advanced disease range from 40% to 60% (Cheng et al, 2012;Di Fiore et al, 2006;Tamtai et al, 2017).…”

“…(Torre et al, 2015;Tamtai et al, 2017). The survival rates of most patients diagnosed with locally advanced disease range from 40% to 60% (Cheng et al, 2012;Di Fiore et al, 2006;Tamtai et al, 2017).…”