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Annals of Oncology Advance Access published online on May 22, 2009
Annals of Oncology, doi:10.1093/annonc/mdp045
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Multicenter phase II trial of preoperative induction chemotherapy followed by chemoradiation with docetaxel and cisplatin for locally advanced esophageal carcinoma (SAKK 75/02)

T. Ruhstaller1,*, L. Widmer2, J. C. Schuller3, A. Roth4, V. Hess5, W. Mingrone6, R. von Moos7, M. Borner8, B. C. Pestalozzi9, S. BalmerMajno10, D. Köberle1, L. Terraciano11, A. Schnider12, S. Bodis13, R. Popescu14 and for the Swiss Group for Clinical Cancer Research (SAKK)

1 Department of Oncology and Hematology, Kantonsspital, St Gallen, St Gallen
2 Department of Oncology, Triemlispital Zurich, Zurich
3 Coordination Center, SAKK Bern, Bern
4 Oncosurgery, Department of Surgery, University Hospital of Geneva, Geneva
5 Division of Medical Oncology, Department of Internal Medicine, University Hospital of Basel, Basel
6 Department of Oncology and Hematology, Kantonsspital Aarau, Aarau
7 Department of Medical Oncology and Hematology, Kantonsspital Graubünden, Chur
8 Institute of Medical Oncology, Inselspital Bern, Bern
9 Department of Oncology, University Hospital of Zurich, Zurich
10 Department of Radiation Oncology, University Hospital of Geneva, Geneva
11 Institute of Pathology, University Hospital of Basel, Basel
12 Department of Surgery, Triemlispital Zurich, Zurich
13 Institute for Radio-Oncology, Kantonsspital Aarau, Aarau
14 Tumor Center, Hirslanden Clinic Aarau, Aarau, Switzerland

* Correspondence to: Dr T. Ruhstaller, Fachbereich Onkologie/Hämatologie, Kantonsspital St Gallen, 9007 St Gallen, Switzerland. Tel: +41-71-494-11-77; Fax: +41-71-494-63-68; E-mail: thomas.ruhstaller{at}kssg.ch

Background: This multicenter phase II study investigated the efficacy and feasibility of preoperative induction chemotherapy followed by chemoradiation and surgery in patients with esophageal carcinoma.

Patients and methods: Patients with locally advanced resectable squamous cell carcinoma or adenocarcinoma of the esophagus received induction chemotherapy with cisplatin 75 mg/m2 and docetaxel (Taxotere) 75 mg/m2 on days 1 and 22, followed by radiotherapy of 45 Gy (25 x 1.8 Gy) and concurrent chemotherapy comprising cisplatin 25 mg/m2 and docetaxel 20 mg/m2 weekly for 5 weeks, followed by surgery.

Results: Sixty-six patients were enrolled at eleven centers and 57 underwent surgery. R0 resection was achieved in 52 patients. Fifteen patients showed complete, 16 patients nearly complete and 26 patients poor pathological remission. Median overall survival was 36.5 months and median event-free survival was 22.8 months. Squamous cell carcinoma and good pathologically documented response were associated with longer survival. Eighty-two percent of all included patients completed neoadjuvant therapy and survived for 30 days after surgery. Dysphagia and mucositis grade 3/4 were infrequent (<9%) during chemoradiation. Five patients (9%) died due to surgical complications.

Conclusions: This neoadjuvant, taxane-containing regimen was efficacious and feasible in patients with locally advanced esophageal cancer in a multicenter, community-based setting and represents a suitable backbone for further investigation.

chemoradiation, esophageal carcinoma, esophagus, induction chemotherapy, preoperative

Received for publication September 7, 2008. Revision received January 14, 2009. Accepted for publication January 28, 2009.


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