Pilot Study of Preoperative Combined Modality Treatment for Locally Advanced Operable Oesophageal Carcinoma: Toxicities and Long-term Outcome

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 18; no. 4; pp. 338 - 344
• Main Authors: Mukherjee, S., Abraham, J., Brewster, A., Hardwick, R., Havard, T., Lewis, W., Askill, C., Manson, J., Williams, G.T., Roberts, S.A., Court, J., Crosby, T.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-05-2006
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemoradiation; Cisplatin - administration & dosage; Cisplatin - adverse effects; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - surgery; Feasibility Studies; Female; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Humans; Male; Middle Aged; Neoadjuvant Therapy; paclitaxel; Paclitaxel - administration & dosage; Paclitaxel - adverse effects; pre-operative; Preoperative Care; Prospective Studies; Radiotherapy, Conformal; response rate; Survival Analysis; toxicity; toxicity; paclitaxel; pre-operative; Chemoradiation; response rate
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2005.12.009

Paclitaxel, a radiosensitiser, has significant activity in oesophageal cancer. We aimed to conduct a feasibility study of preoperative chemoradiation using paclitaxel, cisplatin and 5-fluorouracil (5-FU).
Sixteen eligible patients were enrolled. Infusional 5-FU, paclitaxel and cisplatin were given for 6 weeks before and concurrent with radiation. Conformal radiotherapy was delivered in two phases (45
Gy in 25 fractions).
A total of 62.5% of the patients experienced Grade 3–4 toxicities, 50% required admission; one patient died during the neo-adjuvant phase.
Twelve (75%) patients had oesophagectomy, and two (12.5%) died after surgery. Pathological complete remission (PCR) and minimal residual disease were observed in 25% (95% CI 0.5–49.5%) and 18% (95% CI 0–38%) of patients, respectively, who underwent surgery. The median survival was 39.7 months (95% CI 15, not reached); 1-, 2-, 3-, and 4-year survivals were 75% (95% CI 56.5–99.5), 56.3% (36.5–86.7), 50% (30.6–81.6), and 50% (30.6–81.6), respectively.
Paclitaxel, cisplatin and 5-FU (TCF)-chemoradiation is an active regimen; the current dose schedule tested is associated with unacceptable toxicity, and cannot be recommended for routine clinical use.