To investigate the feasibility of preoperative concurrent chemoradiotherapy with Oxaliplatin in the treatment of locally advance potentially operable esophageal cancer.
Between October 2009 and October 2011, 35 consecutive patients with newly diagnosed esopahgeal cancer AJCC clinical stage T2-4N0-2M0 were enrolled into this study. One dose of chemotherapy with oxaliplatin 35mg/m2 iv for two hours on Day1 and Day2, leucovorin 200mg/m2 iv for two hours on Day1 and 5-FU 2400mg/m2 iv continuously for 48 hours on Day1 was given two weeks before preoperative chemoradiotherapy (CCRT). During preoperative CCRT, radiation doses of 4500cGy in 25 fractions was given to clinical target volume (CTV) and 5000cGy to 5040cGy in 25 fractions was given to gross tumor volume (GTV); chemotherapy with Oxaliplatin 45mg/m2 iv for two hours on Day 1 of radiation therapy(R/T) every 14 days, 5-FU 400mg/m2 iv bolus one hour for 5 days on week 1 and week 5 of R/T. Tumor response assessments were performed 3 weeks after preoperative CCRT was completed. Surgery was performed 4-6 weeks after preoperative CCRT. The pathologic response, overall survival, disease free survival, local recurrent rates and treeatment related toxicities were analyzed.
Four patients withdrew from this study. The total numbers of the patients for analysis are 31. The median follow-up period is 63.4 months. The resection rate is 64.5% (20/31). The pathologic complete response rate is 15% (3/20). The estimate 5-year overall survival rate is 35.5%. The estimate 5- year overall survival rate of the patient with and without surgery after preoperative CCRT are 45% and 18.1%, respectively (p = 0.2822). The local recurrence rate is 20.6% (20.2% in patients with surgery and 22.2% in patients without surgery). The acute toxicities are mild and no grade 3 or above hematology toxicity. One patient has grade 3 esophagitis. Grade 3 pulmonary toxicity happened in 16.1% (5/31) of the patients.
Preoperative chemoradiotherapy with oxaliplatin in the treatment of locally advance potentially operable esophageal cancer is feasible and safe. There is a trend toward improved survival in the patients who received preoperative chemoradiotherapy followed by surgery.
Clinical trial identification
Protocol No/ IRB TCVGH No: S08130
All authors have declared no conflicts of interest.