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Phase 2 trial of induction and concurrent chemoradiotherapy with weekly irinotecan and cisplatin followed by surgery for esophageal cancer
Cancer,
Clinical Article
Ilson DH et al. – Weekly treatment with irinotecan, cisplatin, and radiation achieved results no better and potentially inferior to other phase 2 chemoradiotherapy trials with a low rate of pathologic complete response (pCR). The use of positron emission tomography (PET) scan after induction chemotherapy to direct chemotherapy during subsequent radiotherapy merits further study.
Methods- Patients with uT1N1M0 or uT2-4NanyM0 resectable squamous cancer or adenocarcinoma of the esophagus or GEJ received irinotecan 65mg/m2 and cisplatin 30mg/m2 for 4 treatments in weeks 1 through 5, followed by 4 treatments in weeks 7 through 11 with 50.4Gy in daily fractions, followed by surgery.
- The primary endpoint was pathologic complete response (pCR).
- Positron emission tomography (PET) scan was performed prior to chemotherapy and as restaging prior to radiotherapy.
- Fifty-five patients were evaluable, 75% of whom had adenocarcinoma and 65% of whom had uT3N1 disease.
- Thirty-eight patients underwent R0 resection (69%).
- The incidence of pCR was 16% (95% confidence interval, 8%-29%).
- Median overall survival was 31.7months.
- An exploratory analysis of PET response to induction chemotherapy indicated a correlation with pCR (32% vs 4%), R0 resection (84% vs 57%), progression-free survival (24.1 vs 7.7months), and overall survival (40.2 vs 25.5months).