Locally advanced esophageal and GE Junction cancer: Chemotherapy and radiation including paclitacel and carboplatin – pro

Esophageal cancer, including cancer arising from the gastro-esophageal junction, is a challenging disease worldwide. At diagnosis, approximately 50% of patients present with disease that extends beyond the site of origin in the esophagus. The Radiation Therapy Oncology Group (RTOG) study 85-01 compared treatment with 4 cycles of cisplatin plus 5-FU with radiation therapy (50 Gy in 25 fractions) to radiation therapy (64 Gy in 32 fractions) in patients with local-regional thoracic esophageal cancer (T1-3, N0-1, M0) (23) Ninety percent of the patients had squamous cell carcinoma. Patients treated with both chemotherapy and radiation therapy had a significantly better average duration of survival (14 months vs 9 months, p < 0.0001) and more of these patients were alive 5 years after treatment (27% vs 0 %, p < 0.0001). Combined chemotherapy plus radiotherapy became the new standard of care for patients with esophageal cancer that was not amenable to surgical removal. At this point, several other chemo regimens have been studied and are consdired standard with radiation, among them capecitabine as noted above.

A study by Horning et al showed that DFS and OS for carboplatin/paclitaxel compared with cisplatinum/5-FU as dCRT treatment in EC patients. Toxicity rates were lower in the carboplatin/paclitaxel group together with higher treatment compliance. A study by El-Rayes found that the combination of carboplatin and paclitaxel is an moderately active and tolerable regimen in advanced esophageal cancer.

DeNittis AS. Esophagus. In: Perez CA, Brady LW, Halperin EC (eds): Principles and Practice of Radiation Oncology. 4th edition. Lippincott Williams & Wilkins. 2004, pp 1282-1305.

B. F. El-Rayes, A. Shields, M. Zalupski, L. K. Heilbrun, V. Jain, D. Terry, A. Ferris and P. A. Philip. A phase II study of carboplatin and paclitaxel in esophageal cancer. Ann Oncol (2004) 15 (6): 960-965.

M. Stahl, C. Mariette, K. Haustermans, A. Cervantes, D. Arnold, Oesophageal Cancer: ESMO Clinical Practice Guidelines Ann Oncol 2013; 24 (Suppl 6): vi51-vi56.
J. Honing; J. K. Smit; C. T. Muijs; J. G. M. Burgerhof; J. W. de Groot; G. Paardekooper; K. Muller; D. Woutersen; M. J. C. Legdeur; W. E. Fiets; A. Slot; J. C. Beukema; J. Th. M. Plukker; G. A. P. HospersA Comparison of Carboplatin and Paclitaxel With Cisplatinum and 5-Fluorouracil in Definitive Chemoradiation in Esophageal Cancer Patients. Ann Oncol. 2014;25(3):638-643.

Evidence-based Series #2-11 Version 2.2008: Section 1
Preoperative or Postoperative Therapy for Resectable Esophageal Cancer: Guideline Recommendations
RA Malthaner, RKS Wong, K Spithoff, RB Rumble, L Zuraw,
and the Gastrointestinal Cancer Disease Site Group
A Quality Initiative of the
Program in Evidence-based Care (PEBC), Cancer Care Ontario (CCO)
Report Date: May 21, 2008

Evidence-based Series #2-11 Version 2.2008: Section 1
Preoperative or Postoperative Therapy for Resectable Esophageal Cancer: Guideline Recommendations
RA Malthaner, RKS Wong, K Spithoff, RB Rumble, L Zuraw,
and the Gastrointestinal Cancer Disease Site Group
A Quality Initiative of the
Program in Evidence-based Care (PEBC), Cancer Care Ontario (CCO)
Report Date: May 21, 2008

J. Honing; J. K. Smit; C. T. Muijs; J. G. M. Burgerhof; J. W. de Groot; G. Paardekooper; K. Muller; D. Woutersen; M. J. C. Legdeur; W. E. Fiets; A. Slot; J. C. Beukema; J. Th. M. Plukker; G. A. P. HospersA Comparison of Carboplatin and Paclitaxel With Cisplatinum and 5-Fluorouracil in Definitive Chemoradiation in Esophageal Cancer Patients. Ann Oncol. 2014;25(3):638-643.

M. Stahl et al, Esophageal cancer: Clinical Practice Guidelines for diagnosis, treatment and follow-up
and On behalf of the ESMO Guidelines Ann Oncol (2010) 21 (suppl 5): v46-v49.

nccn.org, Esophageal, 2017

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