A PHASE II STUDY OF A PACLITAXEL-BASED CHEMORADIATION REGIMEN WITH SELECTIVE SURGICAL SALVAGE FOR RESECTABLE LOCOREGIONALLY ADVANCED ESOPHAGEAL CANCER: INITIAL REPORTING OF RTOG 0246

作者：Swisher Stephen G^*; Winter Kathryn A; Komaki Ritsuko U; Ajani Jaffer A; Wu Tsung T; Hofstetter Wayne L; Konski Andre A; Willett Christopher G

来源：International Journal of Radiation Oncology, Biology, Physics, 2012, 82(5): 1967-1972.

DOI：10.1016/j.ijrobp.2011.01.043

• Esophageal cancer
• Chemotherapy
• Chemoradiation
• Radiation therapy
• Salvage surgery

Purpose: The strategy of definitive chemoradiation with selective surgical salvage in locoregionally advanced esophageal cancer was evaluated in a Phase II trial in Radiation Therapy Oncology Group (RTOG)-affiliated sites. %26lt;br%26gt;Methods and Materials: The study was designed to detect an improvement in 1-year survival from 60% to 77.5% (alpha = 0.05; power = 80%). Definitive chemoradiation involved induction chemotherapy with 5-fluorouracil(5-FU) (650 mg/mg(2)/day), cisplatin (15 mg/mg(2)/day), and paclitaxel (200 mg/mg(2)/day) for two cycles, followed by concurrent chemoradiation with 50.4 Gy (1.8 Gy/fraction) and daily 5-FU (300 mg/mg(2)/day) with cisplatin (15 mg/mg(2)/day) over the first 5 days. Salvage surgical resection was considered for patients with residual or recurrent esophageal cancer who did not have systemic disease. %26lt;br%26gt;Results: Forty-three patients with nonmetastatic resectable esophageal cancer were entered from Sept 2003 to March 2006. Forty-one patients were eligible for analysis. Clinical stage was %26gt;= T3 in 31 patients (76%) and N1 in 29 patients (71%), with adenocarcinoma histology in 30 patients (73%). Thirty-seven patients (90%) completed induction chemotherapy followed by concurrent chemoradiation. Twenty-eight patients (68%) experienced Grade 3+ nonhematologic toxicity. Four treatment-related deaths were noted. Twenty-one patients underwent surgery following definitive chemoradiation because of residual (17 patients) or recurrent (3 patients) esophageal cancer, and 1 patient because of choice. Median follow-up of live patients was 22 months, with an estimated 1-year survival of 71%. %26lt;br%26gt;Conclusions: In this Phase II trial (RTOG 0246) evaluating selective surgical salvage after definitive chemoradiation in locoregionally advanced esophageal cancer, the hypothesized 1-year RTOG survival rate (77.5%) was not achieved (1 year, 71%; 95% confidence interval%26lt; 54%-82%).

• 出版日期2012-4-1