Retrospective analysis of neoadjuvant chemoradiotherapy with carboplatin/ paclitaxel versus FOLFOX in newly diagnosed esophageal or junctional cancers: A single instituition experience.

Abstract

168 Background: The retrospective study aimed to evaluate carboplatin / paclitaxel (CP) versus FOLFOX in the neoadjuvant combined modality setting for newly diagnosed esophageal or junctional cancers. Methods: Patients with esophageal or junctional cancers treated in combined modality setting were included. During the study period, there were seventy three patients who had T2-4N0-1M0 esophageal and junctional carcinomas. Results: 49 (67%) patients received CP and 24 (33%) patients received FOLFOX. Concurrent radiation was delivered 5400-cGy in CP arm and 5040-cGy in FOLFOX arm. 38 (78%) patients in CP arm and 19 ( 79 %) in FOLFOX arm underwent curative resection. In CP arm, 11(12%) did not undergo curative resection due to disease progression (5/11), death secondary to infection (2/11) and poor functional status post chemotherapy (4/11). In FOLFOX arm, 5(21%) patients did not have surgery due to progressive disease (3/ 5), sepsis ( 1/ 5) and Tracheo–esophageal fistula ( 1 / 5). In patients who underwent curative resection, overall response rate (RR) was 92% in the CP arm with *CR–10(26%), PR–25 (66%), NR–3 (8%); in FOLFOX arm, RR was 100 % with *CR–6(32 %), PR–13(68 %), NR- 0 (p = 0.06). Median follow-up in all patients was 22 months, with median overall survival (OS) for the CP group 20-months and the FOLFOX group 30.5-months.With curative resection the median OS was 23-months in CP arm and 41-months in FOLFOX arm. Median relapse free survival (RFS) was 9.5-months in CP arm and 11 months in FOLFOX arm. 45% relapsed in the CP arm and 42% relapsed in the FOLFOX arm after curative resection. Conclusions: With CROSS trial in esophageal and juntional cancers, there has been a paradigm shift away from infusional 5-FU based regimens (5FU/cisplatin and FOLFOX). With this study, we demonstrated the activity of FOLFOX in comparison to CP in the neoadjuvant setting with concurrent radiotherapy in the treatment of localized esophageal cancers. There was a trend in clinical efficacy and response rate towards FOLFOX when combined with curative resection. To definitively assess this and compare the efficacy, long term prospective studies are needed.