749 - A phase II trial of neoadjuvant concurrent chemo-radioptherapy containing cisplatin and 5-fu followed by resection for esophageal carcinoma

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Kazem Anvari
Authors K. Anvari1, S.A. Aledavood2, M. Seilanian Tousi3, F. Nosrati3
  • 1Radiation Oncology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad/IR
  • 2Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad/IR
  • 3Cancer Research Center, Omid Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad/IR

Abstract

Introduction

Combined modality treatments have been adopted to improve survival in patients with esophageal carcinoma. In this trial, we evaluated the efficacy and toxicity of a preoperative concurrent chemoradiotherapy protocol in patients with locally advanced esophageal carcinoma.

Method and material

Between 2006 and 2011, eligible patients with locally advanced esophageal carcinoma underwent concurrent radiotherapy (40 Gy/20 fractions) and chemotherapy (cisplatin 20 mg/m2 for 4 days plus 5-FU 700 mg/m2 24-hour infusion for 4 days on the first and the last week of radiation therapy). In patients with unsuitable hematological or general condition only one cycle of chemotherapy was prescribed. The patients underwent esophagectomy 3 to 4 weeks following radiation therapy. Pathologic response, overall survival rate, toxicity and feasibility were evaluated.

Results

197 patients with a median age of 59 (range; 27-70) with a female to male ratio of 100/97 entered the protocol. 194 cases (98.5%) had esophageal SCC. Grades 3-4 of toxicity were as follows: neutropenia in 41 (21%) and esophagitis in 5 (2.5%) cases. There were 11 (5.6%) early death probably due to treatment related toxicities. The other reasons for not completing the protocol were as follows: toxicity in 6 (3%), refusing surgery in 35 (17.8%), improper general condition for surgery in 18 cases (9.1%). 127 cases (64.5%) completed the protocol among which 60 cases received 2 courses of chemotherapy. For patients who underwent surgery, the complete pathological response was shown in 38 cases (29.9%) with a 5-year overall survival rates of 47.2 % and median overall survival of 33 months. There were no significant difference in overall survival rates in patients receiving one or two cycles of chemotherapy (log-rank p = 0.64).

Conclusion

The pathological response rate and the overall survival rate are promising in patients who completed the protocol as receiving at least one cycle of chemotherapy. However, the toxicity rates were relatively high. prescribing two cycles of chemotherapy resulted in no significant improvement in survival rate as compared with those receiving one cycle.

Disclosure

All authors have declared no conflicts of interest.