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Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus.
- Source :
-
Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2000 Feb; Vol. 18 (4), pp. 868-76. - Publication Year :
- 2000
-
Abstract
- Purpose: This phase II trial evaluated continuous-infusion cisplatin and fluorouracil (5-FU) with radiotherapy followed by esophagectomy. The objectives of this trial were to determine the complete pathologic response rate, survival rate, toxicity, pattern of failure, and feasibility of administering adjuvant chemotherapy in patients with resectable cancer of the esophagus treated with preoperative chemoradiation.<br />Patients and Methods: Patients were staged using computed tomography, endoscopic ultrasound, and laparoscopy. The preoperative treatment plan consisted of continuous intravenous infusion of cisplatin and 5-FU and a total dose of 44 Gy of radiation. Esophagogastrectomy was planned for approximately 4 weeks after the completion of chemoradiotherapy. Paclitaxel and cisplatin were administered as postoperative adjuvant therapy.<br />Results: Forty-two patients were enrolled onto the trial. Of the 39 patients who proceeded to surgery, 29 responded to preoperative treatment: 11 achieved pathologic complete response (CR) and 18 achieved a lower posttreatment stage. Five patients had no change in stage, whereas eight had progressive disease (four with distant metastases and four with increases in the T and N stages). At a median follow-up of 30.2 months, the median survival time has not been reached and the 2-year survival rate is 62%. The median survival of pathologic complete responders has not been reached, whereas the 2-year survival rate of this group is 91% compared with 51% in patients with complete tumor resection with residual tumor (P =.03).<br />Conclusion: An excellent survival rate, comparable to that of our prior preoperative trial, was achieved with lower doses of preoperative cisplatin and 5-FU concurrent with radiotherapy.
- Subjects :
- Adenocarcinoma drug therapy
Adenocarcinoma radiotherapy
Adult
Aged
Antimetabolites, Antineoplastic administration & dosage
Antimetabolites, Antineoplastic adverse effects
Antineoplastic Agents administration & dosage
Antineoplastic Agents adverse effects
Antineoplastic Agents, Phytogenic administration & dosage
Antineoplastic Agents, Phytogenic adverse effects
Antineoplastic Combined Chemotherapy Protocols adverse effects
Carcinoma, Squamous Cell drug therapy
Carcinoma, Squamous Cell radiotherapy
Chemotherapy, Adjuvant
Cisplatin administration & dosage
Cisplatin adverse effects
Esophageal Neoplasms drug therapy
Esophageal Neoplasms radiotherapy
Feasibility Studies
Female
Fluorouracil administration & dosage
Fluorouracil adverse effects
Follow-Up Studies
Humans
Male
Middle Aged
Neoplasm Staging
Paclitaxel administration & dosage
Paclitaxel adverse effects
Radiotherapy Dosage
Remission Induction
Survival Rate
Treatment Outcome
Adenocarcinoma surgery
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Carcinoma, Squamous Cell surgery
Esophageal Neoplasms surgery
Esophagectomy
Neoadjuvant Therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0732-183X
- Volume :
- 18
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of clinical oncology : official journal of the American Society of Clinical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 10673530
- Full Text :
- https://doi.org/10.1200/JCO.2000.18.4.868