Preoperative low-dose weekly cisplatin and continuous infusion fluorouracil plus hyperfractionated radiotherapy in stage II–III esophageal carcinoma

• M. Caro ^[3] ; A. Font ^[3] ; S. Comas ^[3] ; M. Viciano ^[4] ; J. Remon ^[1] ; P. Céliz ^[3] ; J. Robles ^[2] ; E. Musulén ^[4] ; M. J. Sendrós ^[3] ; E. Mesalles ^[4] ; J. A. Jiménez ^[4] ; J. Boix ^[4] ; A. Arellano ^[3] ; J. Fernández-Llamazares ^[4]
  1. [1] Hospital de Mataró

     Hospital de Mataró

     Barcelona, España

     
  2. [2] Hospital Universitari de Bellvitge

     Hospital Universitari de Bellvitge

     l'Hospitalet de Llobregat, España

     
  3. [3] Institut Català d´Oncologia, España
  4. [4] Hospital Germans Trias i Pujol, España

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 18, Nº. 11 (November 2016), 2016, págs. 1106-1113
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Background The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus.

    Methods Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1–21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy.

    Results From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3–4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4–35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04).

    Conclusions Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.