Background: Concurrent chemoradiotherapy (CRT) using cisplatin (CDDP) and 5-fluorouracil (5-FU) is the standard treatment for unresectable locally advanced esophageal carcinoma. Although this regimen has been widely accepted in Japan, the adverse effect of CDDP such as gastrointestinal and renal toxicity may sometimes be the cause of interruption of the treatment, especially among the elderly patients. Cis-diammine-glycolatoplatinum(nedaplatin: CDGP) is a new platinum agent, which was developed with the aim of decreasing renal and gastrointestinal toxicities but maintaining the effectiveness of CDDP. We reported the efficacy and safety of CRT using CDGP and 5-FU for locally advanced squamous cell carcinoma of the esopahagus.
Patients and methods: Between January 2001 and December 2007, 65 patients with locally advanced esophageal cancer( 39 patients with unresectable tumor( cT4) and 26 patients with distant lymph node or bulkey lymph node metastasis) were eligible and given informed consent and cared by the Department of Surgical Oncology of Osaka City University. Patients received a continuous infusion of 5-FU (250 mg/body) on days 1-21. CDGP was administered at the dose of 10 mg/body by bolus infusion for 1 hour on days 1-5, 8-12 and 15-19 just before radiotherapy. Radiotherapy was delivered in 1.8 Gy fractions, 5 days/week for 4 weeks. For the effective cases of CRT, a surgical resection was followed subsequently and an additional radiotherapy at the dose of 20 Gy was performed for non-effective cases.
Results: Complete or partial response was achieved in 46 patients (71%). Hematologic toxicities such as grades 3 and 4 leucocytopenia developed in 19 patients and thrombocytopenia developed in 20 patients, which were well tolerated by conservative therapy. Gastrointestinal and renal toxicities were developed in only a few patients. There was no CRT-related death. Of all 65 patients, 25 patients underwent a surgical resection while 19 patients could receive a curative resection( R0 operation). In the resected cases, a 5-year survival rate and the median survival time were 27% and 22.5 months, respectively.
Conclusion: Concurrent CRT with CDGP and 5-FU was effective and safe for locally advanced squamous cell carcinoma of the esophagus.