Neoadjuvant, surgery and adjuvant chemotherapy without radiation for esophageal cancer

Bach Ardalan, Seth A. Spector, Alan S. Livingstone, Dido Franceschi, Dmitry Mezentsev, Mayra Lima, Carol P. Bowen-Wells, Lynne Sparling, Eli Avisar, Michelle Sapp, Joyce Rios, Gail Walker, Parvin Ganjei-Azar

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: A phase II trial to evaluate neoadjuvant (NAD), surgery and adjuvant (AD) combination chemotherapy without radiation therapy (RT) for patients with esophageal adenocarcinoma staged with endoscopic ultrasound and CT as T3N1 was carried out. Methods Thirty-three eligible patients were enrolled. NAD therapy was administered in two 49-day cycles and included cisplatin, floxuridine, paclitaxel and leucovorin. Esophageal resection was performed followed by AD therapy. Results: Thirty-three patients initiated NAD therapy; 10 experienced grade 3 and 4 toxicities, which included leucopenia, fatigue, nausea, diarrhea and stomatitis. Additionally, 16 patients experienced grade 1 and 2 hematologic and non-hematologic toxicities. Fifteen patients were down-staged, of whom five were T2, seven were T1, and three had nodal disease with no evidence of residual cancer in the esophageal bed. Fifteen patients remained T3, and two showed progressive disease. Thirty-two patients proceeded to surgery and 30 were resected. Although all resected patients were eligible for AD therapy, 15 did not receive it either because of patient refusal or surgeon recommendation. Fifteen patients received AD therapy: nine who had remained T3 and six who had down-staged. Three patients experienced grade 3 and 4 toxicities similar to those in NAD therapy. Six patients had grade 1 and 2 toxicities. Kaplan-Meier estimates of overall survival at 1, 3 and 5 years were 73% (95% CI: 58-88%), 52% (95% CI: 34-69%) and 29% (95% CI: 13-45%), respectively. Median survival was 42 months. Conclusion: Deletion of RT may safely allow for more aggressive chemotherapy and increase chances of survival. The results need to be confirmed in a randomized phase II or larger phase III trial.

Original languageEnglish (US)
Pages (from-to)590-596
Number of pages7
JournalJapanese journal of clinical oncology
Volume37
Issue number8
DOIs
StatePublished - Aug 1 2007

Keywords

  • Chemo-phase I-II-III
  • Chemotherapy
  • Esophageal cancer
  • GI-esophagus-med
  • GI-esophagus-surg

ASJC Scopus subject areas

  • Oncology

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