Shifting Practice in Definitive Chemoradiation for Localized Esophageal Cancer

Background: The efficacy of carboplatin–paclitaxel in the trimodality setting was demonstrated in the cross trial. Because of better tolerance, that regimen has been adopted as an alternative for patients receiving definitive chemoradiation (dCRT). The purpose of our study was to compare outcomes in patients with localized esophageal and gastroesophageal junction (GEJ) cancer who received dCRT using either platinum–5-fluorouracil (5FU) or carboplatin–paclitaxel. Methods: Medical records and outcomes for all patients diagnosed with localized carcinoma of the esophagus and GEJ at our centre between 2008 and 2015 were reviewed. All patients who underwent dCRT using cisplatin–5FU, carboplatin–5FU, or carboplatin–paclitaxel were included. Results: The 73 identified patients (34 cisplatin–5FU, 13 carboplatin–5FU, 26 carboplatin–paclitaxel) were all prescribed concomitant radiotherapy of 50 Gy in 25 daily fractions. The diagnosis was adenocarcinoma in 64% and squamous cell carcinoma in 36%. Median overall survival (OS) duration for the cisplatin–5FU group was 28 months [95% confidence interval (CI): 19 to 41 months], with a 3-year OS rate of 44%, in contrast to the 15 months (95% CI: 11 to 17 months) and 15% in the carboplatin–paclitaxel group (log-rank p = 0.0047). Median OS duration for the carboplatin–5FU group was 17 months (95% CI: 11 to 68 months) with a 3-year OS rate of 31%. Adjusting for patient and disease factors, better OS durations and rates were associated with cisplatin–5FU (hazard ratio: 0.34; p = 0.0016) and carboplatin–5FU (hazard ratio: 0.55; p = 0.20) than with carboplatin–paclitaxel. Conclusions: In a dCRT regimen, a better OS is associated with cisplatin–5FU than with carboplatin–paclitaxel. Clinical trials to determine optimal chemotherapy regimens are warranted for patients who are not suitable for surgery.