Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy

David J. Adelstein*, Thomas W. Rice, Lisa A. Rybicki, Marjorie A. Larto, Jay Ciezki, Jerrold Saxton, Malcolm DeCamp, John J. Vargo, John A. Dumot, Gregory Zuccaro

*Corresponding author for this work

Research output: Contribution to journalArticle

113 Scopus citations

Abstract

Purpose: A phase II trial of accelerated fractionation radiation with concurrent cisplatin and paclitaxel chemotherapy was performed to investigate the role of the paclitaxel, when substituted for fluorouracil (5-FU), in the chemoradiotherapy of esophageal cancer. Patients and Methods: Patients with an esophageal ultrasound stage of T3 or N1 or M1 (nodal) esophageal cancer were treated with two courses of a cisplatin infusion (20 mg/m2/d for 4 days) and paclitaxel (175 mg/m2 over 24 hours) concurrent with a split course of accelerated fractionation radiation (1.5 Gy bid to a total dose of 45 Gy). Surgical resection was performed 4 to 6 weeks later followed by a single identical postoperative course of chemoradiotherapy (24 Gy) in patients with significant residual tumor at surgery. Toxicity and results of this treatment were retrospectively compared with our previous 5-FU and cisplatin chemoradiotherapy experience. Results: Between September 1995 and July 1997, 40 patients were entered onto this study. Although dysphagia proved worse in our 5-FU-treated patients, profound leukopenia and a need for unplanned hospitalization were significantly more common in the paclitaxel group. Thirty-seven patients (93%) proved resectable for cure. The 3-year projected overall survival is 30%, locoregional control is 81%, and distant metastatic disease control is 44%. When compared with a similarly staged cohort of 5-FU-treated patients, there was no advantage for any survival function studied. Conclusion: This paclitaxel-based treatment regimen for locoregionally advanced esophageal cancer produced increased toxicity with no improvement in results when compared with our previous 5-FU experience. Paclitaxel-based treatments must be carefully and prospectively studied before their incorporation into the standard management of esophageal cancer. (C) 2000 American Society of Clinical Oncology.

Original languageEnglish (US)
Pages (from-to)2032-2039
Number of pages8
JournalJournal of Clinical Oncology
Volume18
Issue number10
DOIs
StatePublished - Jan 1 2000

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Adelstein, D. J., Rice, T. W., Rybicki, L. A., Larto, M. A., Ciezki, J., Saxton, J., DeCamp, M., Vargo, J. J., Dumot, J. A., & Zuccaro, G. (2000). Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy. Journal of Clinical Oncology, 18(10), 2032-2039. https://doi.org/10.1200/JCO.2000.18.10.2032