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Comparing Three Chemoradiotherapy Regimens for Esophageal Squamous Cancer
Definitive chemoradiotherapy without surgery is standard therapy for esophageal squamous cell cancer. Treatment guidelines endorse weekly carboplatin, paclitaxel, and radiotherapy administered preoperatively followed by surgery in this setting. However, the optimal chemotherapy regimen to use in nonoperative management has not been established.
Investigators in China now report results of a multicenter, randomized trial comparing three paclitaxel-containing chemotherapy regimens combined with 61.2 Gy of radiotherapy as definitive treatment without surgery in 321 patients with localized esophageal squamous cancer. Most patients were 65 or older, most had stage III or higher disease, and most had tumors of the upper or middle thoracic esophagus. Patients received intensity-modulated radiotherapy and paclitaxel combined with carboplatin, cisplatin, or 5-FU.
At a median follow-up of 46 months, overall survival (the primary endpoint) did not differ among the three treatment arms, with similar 1-year survival (79%–81%), 2-year survival (61%–67%), and 3-year survival (57%–60%). Progression-free survival also did not differ among treatment arms at 1 year (60%–66%), 2 years (46%–52%), and 3 years (46%–50%). Locoregional recurrence and distant metastasis-free survival were also similar among treatment arms. Cisplatin was associated with comparatively higher incidence of hematologic and gastrointestinal toxicity, and 5-FU and carboplatin were associated with higher incidence of esophagitis and pneumonitis.
This important trial in esophageal squamous cancer patients treated with definitive chemoradiotherapy suggests comparable efficacy for taxane-based chemotherapy combined with a platinum agent or infusional 5-FU. The study reinforces the acceptable use of weekly carboplatin and paclitaxel with radiotherapy as definitive therapy. The higher radiotherapy dose used in this trial, above standard 50.4 Gy, has not been supported by recent randomized trials.
Ai D et al.
Title: Comparison of 3 paclitaxel-based chemoradiotherapy regimens for patients with locally advanced esophageal squamous cell cancer: A randomized clinical trial.
Source: JAMA Netw Open 2022 Feb 21; [e-pub]. (Abstract/FREE Full Text)