P-0013 Concomitant Docetaxel Based Radiochemotherapy in Esophageal Cancer

Abstract

ABSTRACT Introduction Esophageal cancer is treatable disease, but rarely curable because advanced stages at diagnostic time. The incidence of esophageal cancer has risen in recent decades. In Romania esophageal cancer incidence rate is 1.78%ooo and the mortality rate is 3.45%ooo. The optimal treatment is controversial. Preoperative radiochemotherapy have been evaluated because the majority of newly diagnosed cases are inoperable. Methods 42 patients with squamous cell carcinoma of the esophagus were included in our study between June 2009 and November 2010. The inclusion criteria were: histological confirmed esophageal cancer not amenable for curative surgery, with no distant metastases, ECOG status≤2, adequate blood count, adequate liver, renal and bone marrow function. There were 27 males and 2 females. Median age was 53.3 years. Baseline evaluation consisted in CT scan of the chest and upper abdomen, barium swallow X-ray and endoscopy. The initial treatment was: radiotherapy 40 Gy concomitant with weekly Docetaxel (40 mg/sqm) and Cisplatin (30 mg/sqm), followed by reevaluation using the same methods as baseline. If the tumor become resectable, patients underwent surgery, if not, they continued with radiotherapy up to a total dose of 60 Gy and they received four more chemotherapy cycles consisting of Docetaxel (75 mg/sqm) and Cisplatin (75 mg/sqm) on a three weekly regimen. The operated patients received adjuvant chemotherapy, four cycles of the same Docetaxel and Cisplatin three weekly regimen. Results After 40 Gy, 22 patients had resectable disease, but 3 refused surgery. The other 20 patients had tumor regression with clinical benefit but not operable. For the 19 patients who underwent surgery, the pathology showed: complete pathological remission for 7 patients, microscopic residual disease for 8 patients and 4 patients had macroscopic residual disease. One year survival rate was 61.9%. For the 20 patients who were not operated we performed reevaluation four weeks after the end of chemoradiation. 4 of them had complete remission, 11 partial remission and 5 stable disease. The treatment schedule was well tolerated, with no treatment related death. There were 7 grade 3-4 hematological toxicities, 5 grade 3 emesis and 10 grade 3 mucositis. Conclusion The Docetaxel and Cisplatin weekly chemotherapy regimen was well tolerated in the concurrent administration with radiation therapy. This regimen made 52.3% of the cases resectable and 31.8% of them were complete remissions. Also 25% of unresectable cases had complete remission after chemoradiation. This regimen represents a therapeutic option worthy to be taken into consideration.