Cisplatin- vs. oxaliplatin-based radiosensitizing chemotherapy for squamous cell carcinoma of the esophagus |
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Authors: | Dr. K. Fakhrian MD A. D. Ordu M.D. B. Haller Ph.D. J. Theisen M.D. F. Lordick M.D. V. Bišof M.D. M. Molls M.D. H. Geinitz M.D. |
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Affiliation: | 1. Department of Radiation Oncology, Marien Hospital Herne, University Clinic of the Ruhr University Bochum, H?lkeskampring 40, 44625, Herne, Germany 2. Department of Radiation Oncology, University of Bochum, Bochum, Germany 3. Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universit?t München, Munich, Germany 4. Department of Epidemiology and Medical Statistics, Klinikum rechts der Isar, Technische Universit?t München, Munich, Germany 5. Department of Surgery, Klinikum rechts der Isar, Technische Universit?t München, Munich, Germany 6. University Cancer Center Leipzig (UCCL), University Clinic Leipzig, Leipzig, Germany 7. Department of Internal Medicine III (Hematology/Oncology), Klinikum rechts der Isar, Technische Universit?t München, Munich, Germany 8. Department of Oncology, Clinical Hospital Centre Zagreb, Zagreb, Croatia 9. Department of Radiation Oncology, Krankenhaus der Barmherzigen Schwestern Linz, Linz, Austria
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Abstract: | Purpose To compare the outcomes of two neoadjuvant radiochemotherapy (N-RCT) regimens for squamous cell carcinoma of the esophagus (ESCC). Methods The standard N-RCT regimen for ESCC at our institution between 2002 and 2011 was a total dose of 45 Gy (1.8-Gy fractions) with concomitant cisplatin (20 mg/m2, days 1–5 and 29–33) and 5-fluorouracil (5-FU; 225 mg/m2, 24 h continuous infusion on days 1–33). During the same period, a phase I/II study comparing the standard ESCC N-RCT protocol with a regimen identical except for the replacement of cisplatin with weekly oxaliplatin (40–50 mg/m2) was performed at our center. The standard regimen was used to treat 40 patients; 37 received the oxaliplatin regimen. All patients subsequently underwent radical resection with reconstruction according to tumor location and two-field lymph node dissection. Results Median follow-up time from the start of N-RCT was 74 months (range 3–116 months). The two patient groups were comparable in terms of demographic and baseline tumor characteristics. R0 resection was achieved in 37/39 patients (95?%) in the cisplatin-based N-RCT group, compared to 24/37 (65?%) in the oxaliplatin-based group (p?=?0.002). A pathological complete response (pCR) was seen in the resection specimens from 18/39 patients (46?%) in the cisplatin-based N-RCT group and in 8/37 (22?%) oxaliplatin-group patients. In the cisplatin group, 2- and 5-year overall survival (OS) rates were 67?±?8?% and 60?±?8?%, respectively (median OS 103 months), compared to 38?±?8?% and 32?±?8?%, respectively, for the oxaliplatin group (median OS 17 months; hazard ratio, HR 0.452; 95?% confidence interval, CI 0.244–0.839; p?=?0.012). Conclusion Oxaliplatin-based N-RCT resulted in poorer outcomes in ESCC patients and should not routinely replace cisplatin-based N-RCT. |
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