Abstract
15174 Background: We analyse induction therapy with PTF before local definitive therapy in terms of response, resectability, toxicity and survival. Methods: Patients (pts) with locally advanced esophageal carcinoma were included. Treatment: Paclitaxel 175 mg/m2 and CDDP 75 mg/m2 on day 1 and 5FU 800 mg/m2/day, days 1–4, every 21 days. After 2–3 cycles surgery is considered. If unresectable, Radiotherapy (64 Gy) and concomitant Carboplatin (60 mg/m2, d 1–5 during 1st and 4th week of RT) are planned. Results: From May-02 to October-06 31 pts were treated (28M, 3F) Age: 55 (32–70) PS 0–1: 6–25. Location: Upper 10, Middle 13, Distal 7, Whole 1. Pathology: Squamous 29, Adenocarcinoma 2. T3/4:14/17 N0/1:8/23 M1a: 3. Weight loss >10 kg 12 pts. 87 cycles have been delivered. Range: 2–4. Mean 2,83. Median 3. Toxicity (episodes): hematological 3/4: no episodes. Emesis 3: 2. Mucositis 3: 2. Asthenia 2/3: 8. 2 pts died in remission due to gastrostomy complications and esophago-tracheal fistula, treatment related. Response: CR 5, PR 9, SD 13, PD 4. Treatment after PTF: Surgery 10 pts (1 upper, 5 middle, 4 distal). 1 distal unresectable at surgery, 2 middle not resected because of liver cirrhosis and liver metastases at surgery. pCR: 1. pPR 6 (R0: 3, R1: 3) Chemoradiation with concomitant Carboplatin: 19, making 3 SD in PR, 2 PR in CR and 1 SD in CR. One PR and 4 SD progressed after chemoradiation. Progression: 21 (local 7, systemic 7, both 7). Died: 19 (16 of disease, 2 of complications of gastrostomy, 1 unrelated) Median PFS: 48,28 weeks (95% CI 32,80 - 63,77). Median OS: 51,14 weeks (95% CI 28,81 - 73,47). Conclusions: This schedule has a good toxicity profile. Surgical rescue is possible in almost a half of middle and distal tumours. Chemoradiation is the best approach for unresectable tumours. Considering stage at diagnosis, survival curves are promising. No significant financial relationships to disclose.
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