Mature Survival Results with Preoperative Cisplatin, Protracted Infusion 5-FU, and 45 GY Radiotherapy for Esophageal Cancer
Diana Stripp, MD
University of Pennsylvania Cancer Center
Last Modified: November 5, 2001
Presenter: L. Kleinberg
Presenter's Affiliation: Johns Hopkins Oncology Center, Baltimore, MD
Type of Session: Scientific
- Neoadjuvant chemoradiation for Esophageal cancer is controversial, however, many patients are offered this therapy as a standard of treatment.
- Randomized trials has shown mixed results
- The US Intergroup study closed early due to lack of recruitment
- This study is designed to assess long-term survival results after cisplatin, protracted infusion 5-FU and concurrent radiotherapy followed by surgical resection of esophageal cancer.
- 92 patients with esophageal cancer were treated on two sequential protocols of preoperative chemoradiotherapy.
- Trial A (1989- 1994), 50 patients were treated with 44 Gy RT (2 Gy/day) along with concurrent 5FU protracted infusion and cisplatin.
- Trial B (1995-1997, 42 patients), the chemotherapy doses of 5FU and cisplatin were reduced during RT and three cycles paclitaxel and cisplatin were given postoperatively.
- The promising 5 year survival results and low rate of late cancer related deaths suggests that these regimens of intensive neoadjuvant therapy may improve the overall cure rate.
- Pathologic stage after neoadjuvant therapy is an important predictor of survival and may be useful in selecting patients for intensified adjuvant therapies.
- Although complete response of local disease is associated with long-term survival, isolated local failure is uncommon indicating that efforts to improve the therapeutic outcome should focus on optimizing systemic therapy rather than intensifying the radiotherapy.
- Additional randomized data are needed to fully assess the benefits of this therapeutic approach.
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