Chemotherapy with cisplatinum, carboplatin and 5FU-folinic acid, followed by concomitant chemo-radiotherapy in unresectable esophageal carcinomas

The best chemotherapeutic regimen for advanced carcinoma of the esophagus r emains to be determined We have evaluated a combination of carboplatin, cis platin and 5FU modulated by folinic acid Patients. Twenty-seven patients (m edian age 57 yrs) with an unresectable carcinoma of the esophagus were incl uded in this trial. 9 patients with a local relapse after surgery, 6 patien ts with a locally advanced (T4) tumor and 12 patients with metastasis. Trea tment schedule. Initial chemotherapy : carboplatine IV dl, AUC4; 5FU: bolus injection of 400 mg/m(2) dl, followed by a continuous infusion of 600 mg/m (2)/24 h, d1 and d2; folinic acid (200 mg/m(2)) IV, before the 5FU bolus, d l and d2; cisplatine 80 mg/m(2), d3; on d15 and d16 5FU and folinic acid we re repented with the same schedule. The second cycle began on d28. Concomit ant chemoradiotherapy with 5FU (1,000 mg/m(2) dl to d3), cisplatine (50 mg/ m(2) d1 and d2) and external irradiation (20 Gy in 10 fractions from d1 to d2) runs then performed, for three cycles (until a total dose Of 60 Gy) Res ults. Toxicity: neutropenia grade 3-4 (32%), thrombopenia grade 3-4 (18%). More Important, a lymphopenia (< 500/mm(3)) was noted in 12 patients (43%). Accordingly, 4 serious infectious complications were observed with three t oxic deaths. Objective response rate. 44% after initial chemotherapy; 75% a fter chemoradiotherapy, with 8 complete responses (38%). Median survival wa s 7.4 months, with a one- and two-year survival of 33% and 17,8%, respectiv ely. Conclusion. This association of cisplatin, carboplatin, and 5FU did no t offer a better response rate than the classical 5FU-cisplatinum associati on. But serious infectious complications occurred during the trial We do no t recommended further evaluation of this biplatinum therapy with 5FU in adv anced esophageal carcinomas.