A Phase II Study of a Paclitaxel Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246

Carolyn Vachani, RN, MSN, AOCN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 5, 2007

Scientific Session: A Phase II Study of a Paclitaxel Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246

Prior studies (RTOG 8501) have demonstrated that chemoradiation is more effective than radiation alone in the treatment of esophageal cancer.& However, in this study the majority of patients had squamous cell carcinoma, while the most common type of esophageal cancer at present is adenocarcinoma. There was also still a high rate of local recurrence. This study used chemotherapy with 5-FU, cisplatin and taxol, followed by chemoradiation (5-FU and cisplatin), and then surgery if disease remained.

The 40 participants (ages 42-81) were mostly male (83%), and most had adenocarcinoma (73%). Seventy-five percent had T3 or T4 disease, and 70% had N1 disease. Follow-up was 22 months. One- year survival was 71%. Of 17 patients alive and without evidence of disease, 12 had surgery.

Surgery is thought to help improve local control following chemoradiation. This study asked the interesting question of whether it is necessary to perform surgery for all patients immediately after chemoradiation, or whether surveillance is sufficient to detect patients with early recurrence, and then only operate on them. It is still early in terms of follow-up, but the results from this study are encouraging, with one-year survival comparable to previous studies of treatment using chemoradiation and surgery. Unfortunately, the authors have not yet completed an analysis of patients with recurrent disease to determine if patients were failing predominantly locally or distantly. Such an analysis would allow for a comparison to historical data on local recurrence, to see if local control appears similar after chemoradiation and surgery. Though still clearly investigational, this study presents an intriguing addition to the on-going story of organ-preservation for esophageal cancers.

Partially funded by an unrestricted educational grant from Bristol-Myers Squibb.