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Esophageal Cancer
Neoadjuvant chemoradiation followed by surgery for resectable cancer

Perioperative chemotherapy for resectable adenocarcinoma of esophagogastric junction and lower esophagus

Concurrent chemoradiation for locally advanced cancer

Chemotherapy for stage IV (metastatic) cancer



Neoadjuvant chemoradiation +/- surgery for resectable cancer

5-FU + Cisplatin + RT
5-FU 800 mg/m2/d civi d1-5 starting on d1, 22, 43, 64, 92
Cisplatin (CDDP) 15 mg/m2/d iv over 1 h d1-5 starting on d1, 22, 43, 64, 92
Radiotherapy 2 Gy/d to 66 Gy over 6.5 weeks

Bedenne L et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin  Oncol 2007; 25:1160 (link to the article).

5-FU + Cisplatin + RT + Surgery

5-FU 15 mg/kg/d iv over 16 hours d1-5 week 1 and 6
Cisplatin (CDDP) 75 mg/m2 iv over 8 hours d7 week 1 and 6
Concurrent radiotherapy 2.67 Gy/d to 40 Gy over 3 weeks
Surgery

Walsh TN et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Eng J Med 1996; 335:462 (link to the article).

5-FU + Cisplatin + Vinblastine + RT + Surgery
5-FU 300 mg/m2/d civi d1-21
Cisplatin (CDDP) 20mg/m2/d civi d1-5 and 17-21
Vinblastine 1 mg/m2/d iv bolus d1-4 and 17-20
Concurrent radiotherapy 45 Gy
Surgery

Urba SG et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19:305 (link to the article).


Perioperative chemotherapy for resectable adenocarcinoma of esophagogastric junction and lower esophagus (back to top)

ECF + surgery + ECF
Epirubicin 50 mg/m2 iv d1
Cisplatin (CDDP) 60 mg/m2 iv d1
5-FU 200 mg/m2/d civi
Q3w x 3 cycles
Surgery 3-6 weeks after chemotherapy
6-12 weeks after surgery, repeat the chemotherapy:
Epirubicin 50 mg/m2 iv d1
Cisplatin (CDDP) 60 mg/m2 iv d1
5-FU 200 mg/m2/d civi
Q3w x 3 cycles

Cunningham D et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Eng J Med 2006; 355:11 (link to the article).

FP + Surgery +/- FP
5-FU 800 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv over 1 h d1 or d2
Q4w x 2-3 cycles 
Surgery 4-6 weeks after chemotherapy
4-6 weeks after surgery, repeat the chemotherapy if response to preoperative chemotherapy or stable disease with pN+:
5-FU 800 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv over 1 h d1 or d2
Q4w x 3-4 cycles

Boige V et al. Final results of a randomized trial comparing preoperative 5-fluorouracil  (F) / cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. 2007 ASCO annual meeting. Abstract 4510 (link to the abstract). 

Concurrent chemoradiation for locally advanced cancer (back to top)

5-FU + Cisplatin + RT
5-FU 1000 mg/m2/d civi d1-4 of week 1, 5, 8 and 11
Cisplatin (CDDP) 75 mg/m2 iv d1 of week 1, 5, 8 and 11
Radiotherapy 50 Gy

Herskovic A et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Eng J Med 1992; 326:1593 (link to the article).


Chemotherapy for stage IV (metastatic) cancer (back to top)

5-FU + Cisplatin
5-FU 1000 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv d1
Q3w

Bleiberg, H et al. Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer 1997; 33:1216 (link to the article).

Cisplatin + Paclitaxel
Cisplatin (CDDP) 75 mg/m2 iv d2
Paclitaxel (Taxol) 200 mg/m2 civi over 24hrs d1
Q3w
G-CSF support

Ilson, DH et al. A phase II trial of paclitaxel and cisplatin in patients with advanced carcinoma of the esophagus. Cancer J 2000; 6:316 (link to the article).

Cisplatin + Irinotecan
Cisplatin (CDDP) 30 mg/m2 iv
Irinotecan (Camptosar, CPT-11) 65 mg/m2 iv
Qw

Ilson, DH et al. Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J Clin Oncol 1999; 17:3270 (link to the article).

Epirubicin + Cisplatin + 5-FU (ECF)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Cisplatin (CDDP) 60 mg/m2 iv d1 q3w x 8 cycles
5-FU 200 mg/m2/d civi for 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article). 

Ross, P et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 2002; 20:1996 (link to the article).

Epirubicin + Cisplatin + Capecitabine (ECX)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Cisplatin (CDDP) 60 mg/m2 iv d1 q3w x 8 cycles
Capecitabine (Xeloda) 625 mg/m2 po bid x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Oxaliplatin + Capecitabine
Oxaliplatin (Eloxatin) 130 mg/m2 iv d1
Capecitabine (Xeloda) 850-1000 mg/m2 po bid x 14 days
Q3w

Meerten EV et al. First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic eosophageal cancer: a phase II study. Br J Cancer 2007; 96:1348 (link to the article). 

Jatoi A et al. Oxaliplatin and capecitabine in patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction and gastric cardia: a phase II study from the North Central Cancer Treatment Group. Ann Oncol 2006; 17:29 (link to the article

Epirubicin + Oxaliplatin + 5-FU (EOF)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles
5-FU 200 mg/m2/d civi x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Epirubicin + Oxaliplatin + Capecitabine (EOX)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles
Capecitabine (Xeloda) 625 mg/m2 po bid x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Paclitaxel
Paclitaxel (Taxol) 250 mg/m2 civi over 24 hrs
Q3w
Filgrastim (Neupogen) support

Ajani, JA et al. Activity of taxol in patients with squamous cell carcinoma and adenocarcinoma of the esophagus. J Natl Cancer Inst 1994; 86:1086 (link to the article).

Vinorelbine
Vinorelbine (Navelbine) 25 mg/m2 iv
Qw

Conroy, T et al. Phase II trial of vinorelbine in metastatic squamous cell esophageal carcinoma. European Organization for Research and Treatment of Cancer Gastrointestinal Treat Cancer Cooperative Group. J Clin Oncol 1996; 14:164 (link to the article).