Short report of esophageal Cancer.docx
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ShortreportofesophagealCancer
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[3,4].(china)Paclitaxel,anewbroad-spectrumcytotoxicantineoplasticisnowwidelyusedforthetreatmentofovariancancer,breastcancer,andlungcancer,andrecently,hasshownsomepromisingresponsesagainstdigestivetractcancer.MultiplePhaseI–IIstudieshavedemonstratedthatTaxaneshavesignificantactivityinpatientswithlocallyadvancedandmetastaticesophagealcancer[2,5-9].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,chest