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10.1245/ASO.2006.01.001
Annals of Surgical Oncology 13:214-220 (2006)
© 2006 Society of Surgical Oncology
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Original Article

Induction Cisplatin and Paclitaxel Followed by Combination Chemoradiotherapy with 5-Fluorouracil, Cisplatin, and Paclitaxel Before Resection in Localized Esophageal Cancer: A Phase II Report

Leonard R. Henry, MD1, Melvyn Goldberg, MD1, Walter Scott, MD1, Andre Konski, MD2, Neal J. Meropol, MD3, Gary Freedman, MD2, Louis M. Weiner, MD3, Perry Watts, MSIS4, Mary Beard, BA, CTR, CCRP5, Susan McLaughlin, RN, CCRP5 and Jonathan D. Cheng, MD3

1 Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111
2 Department of Radiation Oncology, Fox Chase Cancer Center 333 Cottman Avenue, Philadelphia, Pennsylvania 19111
3 Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111
4 Department of Biostatistics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111
5 Office of Protocol Management, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111

Correspondence: Address correspondence and reprint requests to: Jonathan D. Cheng, MD; E-mail: j_cheng{at}fccc.edu.

Background: Multimodality therapy for esophageal cancer holds promise for improving outcome in this lethal disease. On the basis of encouraging data from a phase I trial, we conducted a phase II study of preoperative chemotherapy, followed by concurrent chemoradiotherapy and surgery.

Methods: Patients with clinically staged resectable esophageal cancer were treated with induction cisplatin and paclitaxel, followed by 45 Gy of external beam radiation with concurrent infusional 5-fluorouracil and weekly cisplatin and paclitaxel. Four to eight weeks after multimodality induction, esophagectomy was performed in suitable patients. Study end points were survival, pathologic complete response, and toxicity.

Results: Twenty-one patients were enrolled with a median age of 58 years, and all patients were clinically staged II or III. Sixteen (76.2%) patients completed the trial, of whom four (25%) had a pathologic complete response. One patient died from postoperative complications. Grade 3 or 4 toxicity was observed in 76% of patients, and dose-limiting toxicity was seen in 6 of the first 14 patients, thus necessitating a planned dose reduction of paclitaxel. At a median follow-up of 30 months, 13 patients remain alive. The 2-year disease-specific survival for the study population was 78%.

Conclusions: This regimen of multimodality therapy before resection resulted in an encouraging 2-year survival rate but a disappointing rate of pathologic complete response and was toxic, necessitating a predetermined paclitaxel dose reduction. The incorporation of taxanes into induction strategies for esophageal cancer seems promising, but the optimal schedule remains undefined.

Key Words: Esophageal cancer • Induction • Neoadjuvant • Management • Toxicity






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