Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction

Jaffer A. Ajani, Garrett Walsh, Ritsuko Komaki, Jeff Morris, Stephen G. Swisher, Joe B. Putnam, Patrick M. Lynch, Tsung Teh Wu, Roy Smythe, Ara Vaporciyan, Josephine Faust, Deborah S. Cohen, Rebecca Nivers, Jack A. Roth

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Abstract

BACKGROUND. Patients with localized esophageal carcinoma often develop locoregional and distant disease recurrence. The current study investigated the outcome of a new chemotherapy combination as induction therapy before chemoradiotherapy. METHODS. Forty-three patients with resectable carcinoma of the esophagus or gastroesophageal junction were enrolled. Most of the tumors were endoscopic ultrasonography [EUS] EUST3 (84%) and EUSN1 (63%). The patients received ≤ 2 6-week cycles of CPT-11 and cisplatin followed by chemoradiotherapy (45 grays with 5-fluorouracil and paclitaxel). Five to six weeks after chemoradiotherapy, the patients underwent staging and surgery. The feasibility, curative resection rates, overall and disease-free survival rates, rate of significant pathologic response, and patterns of disease recurrence were assessed. RESULTS. Of the 43 patients, 39 (91%) underwent an R0 resection. Two patients (5%) died after surgery. A pathologic complete response (pathCR) was observed in 11 (28%) of the 39 patients (or 26% of the 43 patients). In addition, 16 patients (41% of 39 patients or 37% of 43 patients) had < 10% viable tumor in the surgical specimen (pathPR). A comparison of endoscopic ultrasonograpy T and N classifications with surgical T and N classifications demonstrated significant down-staging (P < 0.01). The median survival period of all 43 patients was 22.1 months. Patients who had achieved a pathCR or pathPR had a longer median survival (25.6 months) than those who achieved less than a pathPR (18.5 months; P = 0.52). None of the clinical parameters examined were found to correlate with survival or pathologic response. CONCLUSIONS. CPT-11-based induction chemotherapy resulted in substantial pathCR and pathPR rates, both of which lead to a favorable survival outcome. The three-step strategy needs to be developed further, with the investigation of targeted therapies with chemotherapy and radiotherapy.

Original languageEnglish (US)
Pages (from-to)2347-2354
Number of pages8
JournalCancer
Volume100
Issue number11
DOIs
StatePublished - Jun 1 2004
Externally publishedYes

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irinotecan
Esophagogastric Junction
Chemoradiotherapy
Cisplatin
Esophagus
Carcinoma
Drug Therapy
Survival

Keywords

  • Chemoradiotherapy
  • Chemotherapy
  • Esophagus
  • Gastroesophageal junction
  • Locoregional carcinoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction. / Ajani, Jaffer A.; Walsh, Garrett; Komaki, Ritsuko; Morris, Jeff; Swisher, Stephen G.; Putnam, Joe B.; Lynch, Patrick M.; Wu, Tsung Teh; Smythe, Roy; Vaporciyan, Ara; Faust, Josephine; Cohen, Deborah S.; Nivers, Rebecca; Roth, Jack A.

In: Cancer, Vol. 100, No. 11, 01.06.2004, p. 2347-2354.

Research output: Contribution to journalArticle

Ajani, JA, Walsh, G, Komaki, R, Morris, J, Swisher, SG, Putnam, JB, Lynch, PM, Wu, TT, Smythe, R, Vaporciyan, A, Faust, J, Cohen, DS, Nivers, R & Roth, JA 2004, 'Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction', Cancer, vol. 100, no. 11, pp. 2347-2354. https://doi.org/10.1002/cncr.20284
Ajani, Jaffer A. ; Walsh, Garrett ; Komaki, Ritsuko ; Morris, Jeff ; Swisher, Stephen G. ; Putnam, Joe B. ; Lynch, Patrick M. ; Wu, Tsung Teh ; Smythe, Roy ; Vaporciyan, Ara ; Faust, Josephine ; Cohen, Deborah S. ; Nivers, Rebecca ; Roth, Jack A. / Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction. In: Cancer. 2004 ; Vol. 100, No. 11. pp. 2347-2354.
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abstract = "BACKGROUND. Patients with localized esophageal carcinoma often develop locoregional and distant disease recurrence. The current study investigated the outcome of a new chemotherapy combination as induction therapy before chemoradiotherapy. METHODS. Forty-three patients with resectable carcinoma of the esophagus or gastroesophageal junction were enrolled. Most of the tumors were endoscopic ultrasonography [EUS] EUST3 (84{\%}) and EUSN1 (63{\%}). The patients received ≤ 2 6-week cycles of CPT-11 and cisplatin followed by chemoradiotherapy (45 grays with 5-fluorouracil and paclitaxel). Five to six weeks after chemoradiotherapy, the patients underwent staging and surgery. The feasibility, curative resection rates, overall and disease-free survival rates, rate of significant pathologic response, and patterns of disease recurrence were assessed. RESULTS. Of the 43 patients, 39 (91{\%}) underwent an R0 resection. Two patients (5{\%}) died after surgery. A pathologic complete response (pathCR) was observed in 11 (28{\%}) of the 39 patients (or 26{\%} of the 43 patients). In addition, 16 patients (41{\%} of 39 patients or 37{\%} of 43 patients) had < 10{\%} viable tumor in the surgical specimen (pathPR). A comparison of endoscopic ultrasonograpy T and N classifications with surgical T and N classifications demonstrated significant down-staging (P < 0.01). The median survival period of all 43 patients was 22.1 months. Patients who had achieved a pathCR or pathPR had a longer median survival (25.6 months) than those who achieved less than a pathPR (18.5 months; P = 0.52). None of the clinical parameters examined were found to correlate with survival or pathologic response. CONCLUSIONS. CPT-11-based induction chemotherapy resulted in substantial pathCR and pathPR rates, both of which lead to a favorable survival outcome. The three-step strategy needs to be developed further, with the investigation of targeted therapies with chemotherapy and radiotherapy.",
keywords = "Chemoradiotherapy, Chemotherapy, Esophagus, Gastroesophageal junction, Locoregional carcinoma",
author = "Ajani, {Jaffer A.} and Garrett Walsh and Ritsuko Komaki and Jeff Morris and Swisher, {Stephen G.} and Putnam, {Joe B.} and Lynch, {Patrick M.} and Wu, {Tsung Teh} and Roy Smythe and Ara Vaporciyan and Josephine Faust and Cohen, {Deborah S.} and Rebecca Nivers and Roth, {Jack A.}",
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T1 - Preoperative induction of CPT-11 and cisplatin chemotherapy followed by chemoradiotherapy in patients with locoregional carcinoma of the esophagus or gastroesophageal junction

AU - Ajani, Jaffer A.

AU - Walsh, Garrett

AU - Komaki, Ritsuko

AU - Morris, Jeff

AU - Swisher, Stephen G.

AU - Putnam, Joe B.

AU - Lynch, Patrick M.

AU - Wu, Tsung Teh

AU - Smythe, Roy

AU - Vaporciyan, Ara

AU - Faust, Josephine

AU - Cohen, Deborah S.

AU - Nivers, Rebecca

AU - Roth, Jack A.

PY - 2004/6/1

Y1 - 2004/6/1

N2 - BACKGROUND. Patients with localized esophageal carcinoma often develop locoregional and distant disease recurrence. The current study investigated the outcome of a new chemotherapy combination as induction therapy before chemoradiotherapy. METHODS. Forty-three patients with resectable carcinoma of the esophagus or gastroesophageal junction were enrolled. Most of the tumors were endoscopic ultrasonography [EUS] EUST3 (84%) and EUSN1 (63%). The patients received ≤ 2 6-week cycles of CPT-11 and cisplatin followed by chemoradiotherapy (45 grays with 5-fluorouracil and paclitaxel). Five to six weeks after chemoradiotherapy, the patients underwent staging and surgery. The feasibility, curative resection rates, overall and disease-free survival rates, rate of significant pathologic response, and patterns of disease recurrence were assessed. RESULTS. Of the 43 patients, 39 (91%) underwent an R0 resection. Two patients (5%) died after surgery. A pathologic complete response (pathCR) was observed in 11 (28%) of the 39 patients (or 26% of the 43 patients). In addition, 16 patients (41% of 39 patients or 37% of 43 patients) had < 10% viable tumor in the surgical specimen (pathPR). A comparison of endoscopic ultrasonograpy T and N classifications with surgical T and N classifications demonstrated significant down-staging (P < 0.01). The median survival period of all 43 patients was 22.1 months. Patients who had achieved a pathCR or pathPR had a longer median survival (25.6 months) than those who achieved less than a pathPR (18.5 months; P = 0.52). None of the clinical parameters examined were found to correlate with survival or pathologic response. CONCLUSIONS. CPT-11-based induction chemotherapy resulted in substantial pathCR and pathPR rates, both of which lead to a favorable survival outcome. The three-step strategy needs to be developed further, with the investigation of targeted therapies with chemotherapy and radiotherapy.

AB - BACKGROUND. Patients with localized esophageal carcinoma often develop locoregional and distant disease recurrence. The current study investigated the outcome of a new chemotherapy combination as induction therapy before chemoradiotherapy. METHODS. Forty-three patients with resectable carcinoma of the esophagus or gastroesophageal junction were enrolled. Most of the tumors were endoscopic ultrasonography [EUS] EUST3 (84%) and EUSN1 (63%). The patients received ≤ 2 6-week cycles of CPT-11 and cisplatin followed by chemoradiotherapy (45 grays with 5-fluorouracil and paclitaxel). Five to six weeks after chemoradiotherapy, the patients underwent staging and surgery. The feasibility, curative resection rates, overall and disease-free survival rates, rate of significant pathologic response, and patterns of disease recurrence were assessed. RESULTS. Of the 43 patients, 39 (91%) underwent an R0 resection. Two patients (5%) died after surgery. A pathologic complete response (pathCR) was observed in 11 (28%) of the 39 patients (or 26% of the 43 patients). In addition, 16 patients (41% of 39 patients or 37% of 43 patients) had < 10% viable tumor in the surgical specimen (pathPR). A comparison of endoscopic ultrasonograpy T and N classifications with surgical T and N classifications demonstrated significant down-staging (P < 0.01). The median survival period of all 43 patients was 22.1 months. Patients who had achieved a pathCR or pathPR had a longer median survival (25.6 months) than those who achieved less than a pathPR (18.5 months; P = 0.52). None of the clinical parameters examined were found to correlate with survival or pathologic response. CONCLUSIONS. CPT-11-based induction chemotherapy resulted in substantial pathCR and pathPR rates, both of which lead to a favorable survival outcome. The three-step strategy needs to be developed further, with the investigation of targeted therapies with chemotherapy and radiotherapy.

KW - Chemoradiotherapy

KW - Chemotherapy

KW - Esophagus

KW - Gastroesophageal junction

KW - Locoregional carcinoma

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