A comparative study of cisplatin-based definitive chemo-radiation in non-metastatic squamous cell carcinoma of the esophagus
Keywords:
Esophageal cancer, Cisplatin, 5-FU, Paclitaxel, Irinotecan, Definitive chemoradiationAbstract
Introduction: Esophageal cancer is the seventh most frequent malignancy in Iranian men and the fourth most common cancer in Iranian women. It is also among the 10 most frequent cancers in the world. Definitive chemo-radiation using cisplatin with 5-fluorouracil (5-FU) is known as the standard of care among various chemotherapy regimens used with esophageal cancer patients who are not eligible for surgery. Cisplatin with paclitaxel and cisplatin with irinotecan also have been used often during the past five years. The aim of this research was to compare overall survival (OS) and hematological toxicity rates between these regimens.
Methods: This single-institutional study included 55 patients who were treated with definitive chemo-radiation in the radiation-oncology ward at Shohada-e-Tajrish Hospital in Tehran, Iran, between 2006 and 2013. They received one of four regimens, i.e., cisplatin, cisplatin with 5-FU (old chemotherapy regimens), cisplatin with paclitaxel, or cisplatin with irinotecan (new chemotherapy regimens) as part of their definitive chemo-radiation with curative intent. The Kaplan-Meier estimator was used to estimate the overall survival times, which were compared by using the Breslow test.
Results: The follow-up period was between 26-109 months, with a median of 72 months. OS was not different between the old and new chemotherapy regimen groups (p = 0.18). Hematological toxicity (leucopenia) in the old chemotherapy regimen groups (10%) was significantly lower than in the new chemotherapy regimen groups (43%, p = 0.012). But OS in cisplatin or cisplatin with 5-FU scheme was statistically better than with the cisplatin with paclitaxel scheme (p = 0.026, p = 0.028, respectively).
Conclusion: This study showed that OS are similar in both the old and new chemotherapy treatment regimens in esophageal cancer patients who were treated with definitive chemo-radiation. The new chemotherapy treatment regimens should be used with caution as an alternative treatment of cisplatin with 5-FU for further evaluation.
References
Stewart BW, Kleihues P (editors). World cancer report. Lyon: IARC, 2013. ISBN 92-832-0411-5
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer Statistics, 2006. CA Cancer Journal
for Clinicians. 2006; 56(2): 106-30. doi: 10.3322/canjclin.56.2.106.
Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet. 2013; 381(9864): 400- 12. doi: 10.1016/S0140-6736(12)60643-6. PMID: 23374478.
Lepage C, Rachet B, Jooste V, Faivre J, Coleman MP. Continuing rapid increase in esophageal
adenocarcinoma in England and Wales. Am J Gastroenterol. 2008; 103(11): 2694-9. doi: 10.1111/j.1572- 0241.2008.02191.x. PMID: 18853967.
Bhansali MS, Vaidya JS, Bhatt RG, Patil PK, Badwe RA, Desai PB. Chemotherapy for carcinoma of the
esophagus: a comparison of evidence from meta-analyses of randomized trials and of historical control
studies. Ann Oncol. 1996; 7(4): 355-9. doi: 10.1093/oxfordjournals.annonc.a010601. PMID: 8805926.
Urba S. Esophageal cancer: preoperative or definitive chemoradiation. Annals of Oncology. 2004; 15(4):
-96. doi:10.1093/annonc/mdh910.
Bedenne L, Michel P, Bouché O, Milan C, Mariette C, Conroy T, et al. Chemoradiaton followd by surgery
compared with chemoradiation alone in squamous cancer of esophagus: FFCD 9102. J Clin Oncol. 2007;
(10): 1160-8. doi: 10.1200/JCO.2005.04.7118. PMID: 17401004.
Morgan MA, Lewis WG, Crosby TD, Escofet X, Roberts SA, Brewster AE, et al. Prospective cohort
comparison of neoadjuvant chemoradiotherapy versus chemotherapy in patients with esophagus cancer. Br
J Surg. 2007; 94(12): 1509-14. doi: 10.1002/bjs.5671. PMID: 17902093.
National Comprehensive Cancer Network. Clinical Practical Guidelines in Oncology.
Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, et al. Chemoradiotherapy
of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85- 01). Radiation Therapy Oncology Group. JAMA. 1999; 281(17): 1623-7. doi: 10.1001/jama.281.17.1623.
PMID: 10235156.
Stahl M, Budach W, Meyer HJ, Cervantes A. Esophageal cancer: Clinical Practice Guidelines for
diagnosis, treatment and follow-up. Ann Oncol. 2010; 21 Suppl 5: v46-9. doi: 10.1093/annonc/mdq163.
PMID: 20555101.
Ilson DH, Wadleigh RG, Leichman LP, Kelsen DP. Paclitaxel given by a weekly 1-h infusion in advanced
esophageal cancer. Ann Oncol. 2007; 18(5): 898-902. doi: 10.1093/annonc/mdm004. PMID: 17351256.
Adelstein DJ, Rice TW, Rybicki LA, Larto MA, Ciezki J, Saxton J, et al. Does Paclitaxel improve the
chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with
Fluorouracil-based therapy. J Clin Oncol. 2000; 18(10): 2032-9. PMID: 10811667.
Ilson DH, Ajani J, Bhalla K, Forastiere A, Huang Y, Patel P, et al. Phase II trial of paclitaxel, fluorouracil,
and cisplatin in patients with advanced carcinoma of the esophagus. J Clin Oncol. 1998; 16(5): 1826-34.
PMID: 9586897.
Polee MB, Sparreboom A, Eskens FA, Hoekstra R, van de Schaaf J, Verweij J, et al. A phase I and
pharmacokinetic study of weekly paclitaxel and carboplatin in patients with metastatic esophageal cancer.
Clin Cancer Res. 2004; 10(6): 1928-34. doi: 10.1158/1078-0432.CCR-03-0319. PMID: 15041708.
Courrech Staal EF, Aleman BM, van Velthuysen ML, Cats A, Boot H, Jansen EP, et al. Chemoradiation for
esophageal cancer: institutional experience with three different regimens. Am J Clin Oncol. 2011; 34(4):
-9. doi: 10.1097/COC.0b013e3181dbbafe. PMID: 20562589.
Blom RL, Sosef MN, Nap M, Lammering G, van den Berkmortel F, Hulshof MC, et al. Comparison of two
neoadjuvant chemoradiotherapy regimens in patients with potentially curable esophageal carcinoma. Dis
Esophagus. 2014; 27(4): 380-7. doi: 10.1111/dote.12110. PMID: 24006852.
Honing J, Smit JK, Muijs CT, Burgerhof JG, de Groot JW, Paardekooper G, et al. A comparison of
carboplatin and paclitaxel with cisplatinum and 5-fluorouracil in definitive chemoradiation in esophageal
cancer patients. Ann Oncol. 2014; 25(3): 638-43. doi: 10.1093/annonc/mdt589. PMID: 24492674, PMCID:
PMC4433521.
Wang H, Ryu J, Gandara D, Bold RJ, Urayama S, Tanaka M, et al. A phase II studyof paclitaxel,
carboplatin, and radiation with or without surgery for esophageal cancer. J Thorac Oncol. 2007; 2(2): 153- 7. doi: 10.1097/JTO.0b013e31802bff75. PMID: 17410032.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.