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J Thorac Cardiovasc Surg 2003;126:1603-1608
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Preoperative chemotherapy for esophageal cancer with paclitaxel and carboplatin: Results of a phase II trial

^a Weill Medical College of Cornell University, New York, NY, USA

Presented at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, Fla, May 18-21, 2002.

Received for publication November 11, 2002; accepted for publication April 21, 2003.

^* Address for reprints: Nasser K. Altorki, MD, Chief, Division of General Thoracic Surgery, Weill Medical College of Cornell University, 525 East 68th St, Box 110, New York, NY 10021, USA
nkaltork{at}med.cornell.edu

OBJECTIVE: Paclitaxel has one of the highest response rates when used as a single agent in patients with esophageal cancer. The combination of paclitaxel and carboplatin has been shown to be a well-tolerated and safe regimen in non–small cell lung cancer. The objective of this study was to determine the efficacy of preoperative paclitaxel and carboplatin in patients with carcinoma of the esophagus.

PATIENTS AND METHODS: A phase II trial was initiated in January 1999 and concluded in January 2001. All patients had potentially resectable disease (including clinical T4 lesions). Patients with stage I disease and those with visceral metastases were excluded. All underwent preoperative computed tomography scanning and endosonography for staging. Paclitaxel (200 mg/m²) and carboplatin (area under the curve = 6) were given on days 1 and 22. Esophagectomy was carried out on weeks 6 to 8.

RESULTS: Twenty-six (11 epidermoid, 15 adenocarcinoma) patients completed the trial. Median age was 61.5 and 85% were men. Preoperative staging showed: stage IIA, 6 patients; stage IIB, 1 patient; and stage III, 19 patients. All patients completed their preoperative chemotherapy. There was no unexpected chemotherapy-related toxicity. A major clinical response was achieved in 16 patients (61%: 19% complete, 42% partial). Resectability was 77% (20/26). A complete pathologic response was seen in 11% of all patients and in 25% of those with epidermoid cancer. Hospital mortality and morbidity were 4 and 27%, respectively. Overall 3-year survival was 48% (64% for resected patients, median not reached). All 6 unresectable patients died within 6 months of exploration.

CONCLUSION: Paclitaxel-carboplatin combination is a safe and well-tolerated regimen for esophageal cancer with clinical response rates comparable to historical controls. This regimen may be especially suitable for patients with epidermoid cancer, who had a 25% pathological complete response in this report.

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