PACLITAXEL AND RADIATION IN CARCINOMAS OF THE ESOPHAGUS

Background: The combination of chemotherapy and radiotherapy in the tr eatment of locally advanced esophageal cancer has resulted in improvem ent of locoregional turner control and overall survival. However, long -term survival is still poor, indicating the need to search for more a ctive treatments. The potential of paclitaxel in esophageal cancer wil l be briefly reviewed in this paper. Methods: Available data from jour nal articles and abstract books were basis of this review. Results: In locally advanced or metastatic cancer of the esophagus complete respo nses (CR) and partial responses (PR) after single drug treatment with paclitaxel have been reported in 31% of patients. In unresectable dise ase in patients without distant metastases, paclitaxel in combination with cisplatin gave an overall response rate (CR + PR) of 48%. Neoadju vant paclitaxel and cisplatin in unresectable esophageal cancer result ed in 16/23 (70%) CR's and PR's. Pathologically complete responses (pC R) were observed in 4/18 (22%) resected specimens. Mediastinal irradia tion with concurrent paclitaxel in combination with cisplatin/5-fluoro uracil or carboplatin/5-fluorouracil in unresectable disease induced s ignificant downstaging in most patients, facilitating complete resecti ons in 81% of patients. In 20/41 (49%) patients pCR's were reported in the resected specimens. Conclusions: Paclitaxel is an active drug in squamous cell carcinomas and adenocarcinomas of the esophagus. Results are particularly encouraging in the neoadjuvant therapy of unresectab le disease rendering high pCR-rates.