Neoadjuvant concurrent chemoradiotherapy with capecitabine and oxaliplatin in patients with locally advanced esophegeal cancer

Abstract

Evaluation of the feasibility and efficacy of neoadjuvant concurrent chemoradiotherapy (CRT) with capecitabine and oxaliplatin in patients with locally advanced esophageal cancer. Forty-two patients were eligible for the study. The chemotherapy during CRT consisted of two cycles of intravenous oxaliplatin of 120 mg/m(2) on day 1 and oral capecitabine 825 mg/m(2) twice daily on days 1-14 at 3-week intervals. The radiotherapy (1.8 Gy/fraction/day to a total dose of 45 Gy) was delivered to the primary tumor site and regional lymph node. All patients completed the planned treatment. Overall clinical response rate was 54.8% with complete response in 16.7% while pathological response rate was 38%. Anemia was the commonest hematologic toxicity (52.3%) with grade 3 in 4.7%, and esophagitis was the commonest non-hematologic toxicity 59.5% with grade 3 and 4 in 9.5%. No treatment-related death was observed. After a median follow-up duration of 19 months, the 2-year survival rate was 42%, median survival time was 20 months (95%CI: 13.802-26.198), while 2-year progression-free survival (PFS) rate was 32.5% with median PFS time of 15 months (95%CI: 10.042-19.958). Neoadjuvant concurrent CRT with capecitabine and oxaliplatin was found to be well tolerated and effective in patients with locally advanced esophageal cancer; however, these results should be further evaluated in a phase III study.

Effect of Preoperative Chemoradiotherapy on Outcome of Patients with Locally Advanced Esophagogastric Junction Adenocarcinoma—A Pilot Study

“…In our series, toxicity was acceptable, with most adverse events being grade 1 or 2, and no treatmentrelated deaths being recorded. Dose reduction was required in 8 patients, and rates of grades 3 and 4 hematologic and nonhematologic toxicities were similar to those reported in other phase ii trials of preoperative crt (including oxaliplatin and 5fu-based chemotherapy) in esophageal or gej cancer [29][30][31][32] and also by our group in earlier work involving resected high-risk gastric cancer patients 13 . Those results are particularly interesting because our study used a higher radiotherapy dose than that reported in the German study (45 Gy vs. 30 Gy).…”

NEOSCOPE: A randomised phase II study of induction chemotherapy followed by oxaliplatin/capecitabine or carboplatin/paclitaxel based pre-operative chemoradiation for resectable oesophageal adenocarcinoma

“…Single arm phase I–II studies have demonstrated feasibility of oxaliplatin-based nCRT [9], [10], [11], [12], [13], [14], [15]. One randomised phase II study comparing oxaliplatin-5FU-based CRT with cisplatin 5FU-based CRT in patients with inoperable but localised oesophageal cancer has demonstrated no significant difference in survival or toxicity but the ease of administration of oxaliplatin over cisplatin makes it a more attractive option [16].…”

External beam radiotherapy synergizes 188Re-liposome against human esophageal cancer xenograft and modulates 188Re-liposome pharmacokinetics

“…[2][3][4] Although various chemotherapy regimens are available, esophageal cancer carries a very poor prognosis, with a mean survival time of less than 8.1 months. 5 Currently, neoadjuvant treatment (such as capecitabine and cisplatin with concurrent radiotherapy (RT) followed by esophagectomy) is considered the effective treatment for esophageal cancer, 6,7 leading to complete pathologic response at the time of surgical resection and improved local tumor control and eradication of micrometastases. 8 Clearly, the development of novel and potent therapeutics in/not in combination with RT to improve both local and distant tumor control in esophageal cancer is an urgent task.…”