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Preoperative low-dose weekly cisplatin and continuous infusion fluorouracil plus hyperfractionated radiotherapy in stage II–III esophageal carcinoma

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Abstract

Background

The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus.

Methods

Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1–21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy.

Results

From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3–4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4–35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04).

Conclusions

Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.

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Author information

Author notes

  1. P. Céliz

    Present address: Medical Oncology Service, Hospital 12 de Octubre, Madrid, Spain

Authors and Affiliations

  1. Radiation Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain

    M. Caro, S. Comas & A. Arellano

  2. Medical Oncology Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Crta del Canyet, s/n, 08916, Badalona, Barcelona, Spain

    A. Font & P. Céliz

  3. Department of Surgery, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain

    M. Viciano & J. Fernández-Llamazares

  4. Medical Oncology Service, Hospital de Mataró, C/Hospital, 31, Mataro, Spain

    J. Remon

  5. PET Unit, Radiology Department, Hospital Universitari de Bellvitge, Feixa Llarga 0, L’Hospitalet de Llobregat, Spain

    J. Robles

  6. Department of Pathology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain

    E. Musulén

  7. Endocrinology and Nutrition Service, Institut Català d´Oncologia, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Barcelona, Spain

    M. J. Sendrós

  8. Intensive Care Unit, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain

    E. Mesalles

  9. Radiodiagnostic Service, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain

    J. A. Jiménez

  10. Department of Gastroenterology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, Badalona, Spain

    J. Boix

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  1. M. Caro
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  2. A. Font
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Correspondence to A. Font.

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Caro, M., Font, A., Comas, S. et al. Preoperative low-dose weekly cisplatin and continuous infusion fluorouracil plus hyperfractionated radiotherapy in stage II–III esophageal carcinoma. Clin Transl Oncol 18, 1106–1113 (2016). https://doi.org/10.1007/s12094-016-1488-y

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  • DOI: https://doi.org/10.1007/s12094-016-1488-y

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