Improved local control by surgery and paclitaxel-based chemoradiation for esophageal squamous cell carcinoma: Results of a retrospective non-randomized study
Journal
Journal of Surgical Oncology
Journal Volume
98
Journal Issue
1
Pages
34-41
Date Issued
2008
Author(s)
Abstract
Background and Objectives: To investigate the impact of using paclitaxel in chemoradiation on locally advanced esophageal squamous cell carcinoma (SCC) treated with or without surgery. Methods: Of 127 patients with AJCC stages II-III esophageal SCC undergoing definitive chemoradiation (DefCRT, n = 44) or neoadjuvant chemoradiation plus surgery (NeoCRT + S, n = 83), 57 received chemotherapy with paclitaxel and cisplatin (TP), and 70 received 5-fluorouracil and cisplatin (PF). Three-year local progression-free survival (LPFS), distant metastasis-free survival, overall survival, and prognostic factors were retrospectively analyzed. Results: The median survival was 30 months. Pathological complete response rate was 41% and 27% with TP and PF, respectively (P = 0.19). NeoCRT + S achieved significantly higher LPFS than DefCRT (71% vs. 39%, P < 0.001). Patients receiving TP had significantly higher LPFS than PF (74% vs. 48%, P = 0.04). Local control was similar between DefCRT with TP and NeoCRT + S. Distant metastasis-free survival and overall survival were not different between treatment modalities or chemotherapy regimens. In multivariate analysis, surgery (HR 0.30, P < 0.001), TP regimen (HR 0.38, P = 0.007), and mediastinal lymphadenopathy (HR 2.37, P = 0.008) were independent factors for LPFS. Conclusions: Both surgery and the use of paclitaxel-based chemoradiation may improve local disease control. Future randomized trials should integrate paclitaxel into definitive chemoradiation. ? 2008 Wiley-Liss, Inc.
SDGs
Other Subjects
cisplatin; fluorouracil; paclitaxel; adult; advanced cancer; aged; article; cancer adjuvant therapy; cancer combination chemotherapy; cancer control; cancer radiotherapy; cancer survival; continuous infusion; controlled study; drug effect; drug efficacy; drug response; esophageal squamous cell carcinoma; female; human; low drug dose; lymphadenopathy; major clinical study; male; mediastinum lymph node; multivariate analysis; overall survival; priority journal; prognosis; radiation dose; retrospective study; survival time; Taiwan; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Disease-Free Survival; Esophageal Neoplasms; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Paclitaxel; Premedication; Prognosis; Radiation Dosage; Radiotherapy, Adjuvant; Treatment Outcome
Type
journal article