Short report of esophageal Cancer桌面.docx

Short report of esophageal Cancer桌面.docx

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ShortreportofesophagealCancer桌面

AphaseI/IItrialofpaclitaxelandoxaliplatincombinedwithradiotherapyinpatientswithlocalizedesophagealcancer

Abstract

Purpose:

Toassesstheefficacyandtoxicityofpaclitaxelandoxaliplatincombinedwithradiotherapyinpatientswithlocalizedesophagealcancer.

Methods:

Thirty-fourpatientswithlocalizedesophagealcancerweretreatedwithpaclitaxel135mg/m²andoxaliplatin75mg/m²ondays1and29ofa29-daycyclecombinedwith60Gy/30Fradiotherapy.Patientswithlocalizedesophagealcancerwereeligibleforthetrial.

Results:

Thirty-onepatients（31/34）withlocalizedesophagealcancercompletethecombined-modalitytherapywhohadthefollowingcharacteristics:

medianage66years（range39–80）;Karnofskyperformancestatus≥70%.Therewere32patients（94.12%）withsquamous-cellcarcinomaoftheesophagusand1patient（2.94%）hadanadenocarcinomaand1patient（2.94%）hadanadenosqumouscarcinoma.NCIgrade4toxicity（leukopenia）wasobservedinfivepatients.Non-haematologicaltoxicityconsistedmainlyofalopeciaandgrade1/2radiationesophagitisandbronchitisandgastrointestinalreaction.Theoverallresponseratewas93.5%（29/31）with3patients（9.68%）achievingcompleteresponse.Medianoverallsurvivaltimewas14.5months（range2.4–82）andmediantimetoprogressionordistantmetastasiswas22.17months（range?

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–?

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）.Therewerenotreatment-relateddeaths

Conclusion:

Thisregimendemonstratesefficacyandwelltoleranceoftoxicityinpatientswithlocalizedesophagealcancerandmaybeatreatmentoptionforthispopulationinanearfuture.

Keywords:

Oxaliplatin·Paclitaxel·radiotherapy·chemotherapy

localizedesophagealcancer

Introduction:

（japan）Esophagealcancerconstitutesaglobalhealthburden,withbetween400,000and500,000newcasesdiagnosedannually[1,2].Itistheeighthmostcommoncancerworldwideandrankssixthasacauseofcancerdeath[2].Theoverallincidenceofesophagealcancerappearstoberising,principallyduetoanincreaseintheincidenceofadenocarcinomaofthelowerthirdoftheesophagusinwesterncountries[3-5].Thismaybeduetoincreasingratesofobesity,gastro-esophagealreflux,andBarrett’sesophagusinthosecountries.（奥沙利铂+紫衫模板）About90%ofallpatientsdiagnosedwithesophagealcancerwilldieasaconsequenceofthisdisease.Besidesthepredominantlylatediagnosis,anotherreasonforthispoorprognosisofthistumouristhelimitedeffectivenessofsystemictherapy[6].（奥沙利铂+紫衫模板）Evenifthereisnoestablishedstandardchemoradiationtherapy,cisplatin+5-Fucombinedwithradiotherapyareacceptedasastandardofcare[7,8].Oxaliplatinisathird-generationplatinumcompoundwithafavourabletoxicityprofileascomparedtocisplatin[9,10].（china）Paclitaxel,anewbroad-spectrumcytotoxicantineoplasticisnowwidelyusedforthetreatmentofovariancancer,breastcancer,andlungcancer,andrecently,hasshownsomepromisingresponsesagainstdigestivetractcancer.MultiplePhaseI–IIstudieshavedemonstratedthatTaxaneshavesignificantactivityinpatientswithlocallyadvancedandmetastaticesophagealcancer[11-16].Asasingleagent,paclitaxelhasbeenshowntoachievearesponserateof32%inesophagealcancerandgastroesophagealjunctioncancer[10].

（Japan）Ilsonetal.[21]showedthatpaclitaxel80mg/m²administeredbyweekly1-hinfusionwaswelltoleratedandshowedmodestactivityinadvancedesophagealcancer.AphaseItrialinJapanstudiedweeklypaclitaxelforsolidtumors,inwhichpaclitaxelwasadministeredweeklyover1hfor6weeksfollowedbya1-weekbreak.Paclitaxeldosewasescalatedfrom80–120mg/m²withnodoselimitingtoxicityobserved.（Peripheralneuropathydevelopedinallsixpatientswhoreceived120mg/m²/weekandfourpatientsdiscontinuedtreatment[22].Adoseof120mg/m²wasthereforesetasthemaximumacceptabledose（MAD）and100mg/m²recommendedforphaseIIstudies）.Wethereforeevaluatedtheefficacyandtolerabilityofpaclitaxel135mg/m²andoxaliplatin75mg/m²combinedwith60Gy/30Fradiotherapyinpatientswithlocalizedesophagealcancer.（证据不足）.

PatientsandMethods

ThisphaseI/IIstudywasconductedat1stHospitalAffiliatedtoWenzhouMedicalCollege.Eligiblepatientswereadultsofatleast18yearsofage（noupperlimit）withhistologicallyconfirmedsquamouscellcarcinoma,adenocarcinomaoradenosquamouscarcinomaoftheesophagus.（RTOG9405）Karnofskyperformancestatusof70orgreater,（奥沙利铂+紫衫模板）Adequatelydefinedhematological,renal,andhepaticfunctionwererequired[hemoglobin≥90g/L,neutrophils≥1.5×109/L,plateletscount≥100×109/L,creatinine≤1.5timesupperlimitofnormalvalue（ULN）,totalserumbilirubinlevl≤1.5ULNandalanineaminotransferase（ALT）≤2.5ULN],bronchoscopytoexcludeatracheoesophagealfistulaifthelesionwaslessthan30cmfromtheincisors,ch