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- Title
Chemoradiotherapy Using Carboplatin plus Paclitaxel versus Cisplatin plus Fluorouracil for Esophageal or Gastroesophageal Junction Cancer.
- Authors
Jiang, Di Maria; Sim, Hao-Wen; Espin-Garcia, Osvaldo; Chan, Bryan A.; Natori, Akina; Lim, Charles H.; Moignard, Stephanie; Chen, Eric X.; Liu, Geoffrey; Darling, Gail; Swallow, Carol J.; Brar, Savtaj; Brierley, James; Ringash, Jolie; Wong, Rebecca; Kim, John; Rogalla, Patrik; Hafezi-Bakhtiari, Sara; Knox, Jennifer J.; Jang, Raymond W.
- Abstract
Background: Trimodality therapy (TMT) with neoadjuvant chemoradiotherapy (nCRT) using concurrent carboplatin plus paclitaxel (CP) followed by surgery is the standard of care for locoregional esophageal or gastroesophageal junction (GEJ) cancers. Alternatively, nCRT with cisplatin plus fluorouracil (CF) can be used. Definitive chemoradiotherapy (dCRT) with CP or CF can be used if surgery is not planned. In the absence of comparative trials, we aimed to evaluate outcomes of CP and CF in the settings of TMT and dCRT. Methods: A single-site, retrospective cohort study was conducted at the Princess Margaret Cancer Centre to identify all patients who received CRT for locoregional esophageal or GEJ cancer. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method and multivariable Cox regression model. The inverse probability treatment weighting (IPTW) method was used for sensitivity analysis. Results: Between 2011 and 2015, 93 patients with esophageal (49%) and GEJ (51%) cancers underwent nCRT (n = 67; 72%) or dCRT (n = 26; 28%). Median age was 62.3 years and 74% were male. Median follow-up was 23.9 months. Comparing CP to CF in the setting of TMT, the OS and DFS rates were similar. In the setting of dCRT, CP was associated with significantly inferior 3-year OS (36 vs. 63%; p = 0.001; HR 3.1; 95% CI: 1.2–7.7) and DFS (0 vs. 41%; p = 0.004; HR 3.6; 95% CI: 1.4–8.9) on multivariable and IPTW sensitivity analyses. Conclusions: TMT with CF and CP produced comparable outcomes. However, for dCRT, CF may be a superior regimen.
- Subjects
THERAPEUTIC use of antineoplastic agents; CISPLATIN; COMBINED modality therapy; ESOPHAGEAL tumors; FLUOROURACIL; PATIENT aftercare; IDENTIFICATION; LONGITUDINAL method; MULTIVARIATE analysis; PACLITAXEL; PATIENTS; PROBABILITY theory; REGRESSION analysis; STOMACH tumors; SURVIVAL analysis (Biometry); TREATMENT effectiveness; PROPORTIONAL hazards models; RETROSPECTIVE studies; DESCRIPTIVE statistics; CARBOPLATIN; KAPLAN-Meier estimator; CHEMORADIOTHERAPY; EVALUATION
- Publication
Oncology, 2021, Vol 99, Issue 1, p49
- ISSN
0030-2414
- Publication type
Article
- DOI
10.1159/000510446