Postoperative radiotherapy combined with concurrent paclitaxel-nedaplatin chemotherapy for esophageal cancer: a preliminary study

Objective: To investigate the safety and preliminary effect of postoperative intensity-modulated radiotherapy (IMRT) combined with concurrent weekly paclitaxel-nedaplatin chemotherapy for patients with esophageal squamous cell carcinoma. Methods: A total of 52 patients who were treated from 2010 to 2013 were enrolled. The clinical target volume of IMRT included tumor beds and corresponding lymphatic drainage regions at high risk, and the total radiotherapy dose was 50-60 Gy, 2.0 Gy/fraction, 5 fractions per week. The concurrent chemotherapy consisted of nedaplatin 25 mg/m² on D₁ and paclitaxel 4550 mg/m² on and was repeated every week during radiotherapy. Common Terminology Criteria for Adverse Events 4.0 was used to evaluate adverse events, and the Kaplan-Meier method was used for survival analysis. Results: All the patients had good tolerance to the treatment, and 51 patients (98%) completed radiotherapy according to the scheduled regimen. The median number of chemotherapy cycles was 4, and 42 patients (81%) completed ≥ 3 cycles of chemotherapy. Most adverse events were of grade 1-2, and grade 3 adverse events were leucopenia (29%), radiation esophagitis (10%), and anastomotic stenosis (4%). One patient (2%) experienced grade 5 gastroesophageal bleeding. Of all the patients, the median survival time was 38.7 months, and the 1-, 2-, 3-, and 4-year overall survival rates were 83%, 64%, 51%, and 38%, respectively. The overall recurrence rate was 46.2%, and the locoregional recurrence rate and distant metastasis rate were 15% and 37%, respectively. Conclusions: Postoperative IMRT combined with concurrent weekly paclitaxel-nedaplatin chemotherapy for patients with esophageal squamous cell carcinoma is safe and effective, and large-scale prospective randomized studies are needed. (authors)