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Tolerability and efficacy of concurrent chemoradiotherapy comparing carboplatin/paclitaxel versus platinum/5-FU regimen for locally advanced esophageal and esophagogastric junction cancers

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Abstract

Platinum/5-fluorouracil (PF) is commonly used for chemoradiotherapy (CRT) for locally advanced esophageal and esophagogastric junction (EGJ) cancers. Weekly carboplatin and paclitaxel (CP) regimen for preoperative CRT has increased in popularity due to its potentially less toxicity. We retrospectively compared the tolerability and efficacy of these regimens. Patients with esophageal and EGJ squamous cell carcinoma (SCC) or adenocarcinoma who received CRT with curative intent were included. Safety and tolerability during CRT were evaluated using the CTCAE version 4.0. Efficacy was analyzed using pathologic complete response, disease-free survival, and overall survival. One hundred and twenty-four patients were eligible for analysis (CP = 64, PF = 60). Most patients had esophageal cancer (97%) with SCC histology (91%). Preoperative CRT was planned for 43% of patients in the CP group and 34% in the PF group (p = 0.306). The relative dose intensities of cisplatin (67.0%) and 5-fluorouracil (81.4%) were lower than those of carboplatin (86.6%) and paclitaxel (86.2%). No difference in the radiotherapy dose, hospitalization, interruption, or termination was observed between the groups. Dose reduction of chemotherapy was more frequent in the CP group (38 vs. 19%; p = 0.015). Febrile neutropenia was more frequent in the PF group (8 vs. 0%; p = 0.058). All-grade nausea/vomiting was lower in the CP group (20 vs. 38%; p = 0.032). Efficacy was comparable between both regimens. In the multivariate analysis, the CRT regimen was not a significant predictor of survival. The CP regimen had less toxicity than the PF regimen, while efficacy was comparable. A large prospective randomized study is warranted to confirm these results.

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Acknowledgements

NN acknowledges support from the Talent Management Program, Mahidol University and the Ramathibodi Grant for Research Development, Ramathibodi Hospital.

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Authors and Affiliations

  1. Division of Medical Oncology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchatewi, Bangkok, 10400, Thailand

    Amorn Tamtai, Eakapop Sirachainun & Nuttapong Ngamphaiboon

  2. Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Chuleeporn Jiarpinitnun & Poompis Pattaranutaporn

  3. Division of General Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Pitichote Hiranyatheb & Chairat Supsamutchai

  4. Section for Clinical Epidemiology and Biostatistic, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand

    Nattawut Unwanatham

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  1. Amorn Tamtai
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  2. Chuleeporn Jiarpinitnun
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  8. Nuttapong Ngamphaiboon
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Correspondence to Nuttapong Ngamphaiboon.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The Ramathibodi ethic committee approved a waiver of consent for this study as a retrospective chart review. The research involves no more than minimal risk to the subject and is not adversely affect the rights and welfare of the subjects. All patient identifications were protected according to the GCP guideline and not published in the manuscript.

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Tamtai, A., Jiarpinitnun, C., Hiranyatheb, P. et al. Tolerability and efficacy of concurrent chemoradiotherapy comparing carboplatin/paclitaxel versus platinum/5-FU regimen for locally advanced esophageal and esophagogastric junction cancers. Med Oncol 34, 157 (2017). https://doi.org/10.1007/s12032-017-1017-z

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  • DOI: https://doi.org/10.1007/s12032-017-1017-z

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