Annals of Surgical Oncology Cite Track
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10.1245/s10434-007-9582-6
Annals of Surgical Oncology 15:88-95 (2008)
© 2008 Society of Surgical Oncology
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Original Article

A Highly Active and Tolerable Neoadjuvant Regimen Combining Paclitaxel, Carboplatin, 5-FU, and Radiation Therapy in Patients with Stage II and III Esophageal Cancer

L. van de Schoot, MD1, E. A. P. M. Romme, MD1, M. J. van der Sangen, MD2, G. J. Creemers, MD, PhD3, G. van Lijnschoten, MD, PhD4, O. J. Repelaer van Driel, MD, PhD5, H. J. T. Rutten, MD, PhD1 and G. A. P. Nieuwenhuijzen, MD, PhD1

1 Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
2 Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
3 Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
4 Department of Pathology, Catharina Hospital, Eindhoven, The Netherlands
5 Department of Surgery, Maxima Medisch Centrum, Eindhoven, The Netherlands

Correspondence: Address correspondence and reprint requests to: L. van de Schoot, MD; E-mail: scho4190{at}planet.nl

Background: The present phase II study aimed to assess the feasibility and efficacy of a new paclitaxel-based neoadjuvant chemoradiation regimen followed by surgery in patients with stage II–III esophageal cancer.

Methods: From January 2002 to November 2004, 50 patients with a potentially resectable stage II–III esophageal cancer received chemotherapy with paclitaxel, carboplatin, and 5-FU in combination with radiotherapy 45 Gy in 25 fractions. Surgery followed 6–8 weeks after completion of neoadjuvant treatment.

Results: Patient characteristics: male/female: 44/6, median age 60 years (34–75), median WHO 1 (0–2), adenocarcinoma (n = 42), squamous cell carcinoma (n = 8). Toxicity was mild, and 84 % of the patients completed the whole regimen. Forty-seven patients underwent surgery with a curative intention (transhiatal n = 44, transthoracic n = 3).

Pathologic complete tumor regression was achieved in 18 of 47 operated patients (38%). R0 resection was achieved in 45 of 47 operated patients (96%). There were four postoperative deaths (8.5). Postoperative complications were comparable with other studies. After a median follow-up of 41.5 months (21–59) estimated 3- and 5-year survival on an intention-to-treat basis was 56 and 48%. Estimated 3-year survival in responders was 61%, in nonresponders 33 %.

Conclusion: This novel neoadjuvant chemoradiation regimen for treatment of patients with stage II–III esophageal cancer is feasible. Results are encouraging with a high pathologic complete tumor regression and R0 resection rate and an acceptable morbidity and mortality. Preliminary survival data are very promising.

Key Words: Esophageal cancer • Neoadjuvant chemoradiation • Paclitaxel • Pathologic complete response • Tumor regression grade






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