A three-step strategy of induction chemotherapy then chemoradiation followed by surgery in patients with potentially resectable carcinoma of the esophagus or gastroesophageal junction.

摘要: BACKGROUND Patients with locoregional carcinoma of the esophagus or gastroesophageal junction have a poor survival rate after surgery. Preoperative chemotherapy chemoradiotherapy has not improved outcome for these patients. Our study was designed to assess feasibility preoperative induction combination in addition improve curative resection rate, local control, and survival. PATIENTS AND METHODS Patients having histologic proof localized (either squamous cell adenocarcinoma) underwent full classification including endoscopic ultrasonography (EUS). Patients first received up two courses consisting 5-fluorouracil at 750 mg/m2/day as continuous infusion on Days 1–5, cisplatin 15 an intravenous bolus paclitaxel 200 mg/m2 24-hour Day 1. The second course repeated 29. This followed by radiotherapy (45 grays 25 fractions) concurrent admission (300 5 days/week) (20 1–5 radiotherapy). After chemoradiotherapy, patients this approach, rates, patient survival, patterns failure were assessed. RESULTS Thirty-seven 38 enrolled evaluable toxicity survival. Adenocarcinoma distal esophageal location observed frequently. Thirty-five (95%) 37 surgery, all whom had R0 (curative) resection. A pathologic complete response noted 11 (30%) total In addition, (14%) only microscopic carcinoma. According EUS classification, 31 (89%) 35 who surgery T3 whereas according 3 (9%) (P ≤ 0.01). Similarly, 23 (66%) N1 carcinoma, 7 (20%) At median follow-up 20 months (minimum follow-up, 13+ months; maximum 36+ months), duration yet been reached. there deaths related surgery. CONCLUSIONS These data show that three-step strategy paclitaxel-based then is feasible appears quite active junction. Future investigations should focus substituting less toxic agents more systemic therapy newer classes agents. Cancer 2001;92:279–86. © 2001 American Society.