Radiation Therapy and Chemotherapy, With or Without Cetuximab, Followed by Surgery in Treating Patients With Locally Advanced Esophageal Cancer That Can Be Removed by Surgery
Adenocarcinoma of the Gastroesophageal Junction, Esophageal Cancer
About this trial
This is an interventional treatment trial for Adenocarcinoma of the Gastroesophageal Junction focused on measuring stage IIB esophageal cancer, adenocarcinoma of the esophagus, adenocarcinoma of the gastroesophageal junction, squamous cell carcinoma of the esophagus, stage IIIA esophageal cancer, stage IIIB esophageal cancer, stage IIIC esophageal cancer
Eligibility Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed esophageal carcinoma
Meets the following criteria:
Resectable, locally advanced disease as determined by the combination of CT scan, endoluminal ultrasound (EUS), PET scan, and a multidisciplinary team discussion
T2, N1-3; T3, any N; or T4a, any N (if technically resectable with curative intent [R0] as decided by a multidisciplinary team discussion)
- EUS-guided fine-needle aspiration (FNA) allowed, but determines nodal status only if positive FNA
- No T1, any N, M0; or T2, N0, M0; T4a (due to infiltration of the trachea-bronchial tree or organ involvement that cannot be operated on with curative intent [R0] as decided by a multidisciplinary team discussion); T4b; or distant metastasis (M1)
- Type I or II disease according to the Siewert classification
- Squamous cell carcinoma (including basaloid-squamous cell and adenosquamous carcinoma) or adenocarcinoma of the thoracic esophagus or the esophagogastric junction (from 5 cm below the entrance of the esophagus into the thorax to the gastric cardia)
- Patients with obstructive tumors are eligible (obstructive tumors will be considered as locally advanced tumors)
- No cervical esophageal carcinoma and tumors involving the first 5 cm of the thoracic esophagus
- No airway infiltration in case of tumors at or above the tracheal bifurcation
- No peritoneal carcinomatosis in case of adenocarcinomas infiltrating the gastric cardia (i.e., esophagogastric junction carcinoma Siewert type I or II)
PATIENT CHARACTERISTICS:
- WHO performance status 0-1
- Neutrophil count ≥ 1.5 x 10^9/L
- Platelet count ≥ 100 x 10^9/L
- Creatinine clearance > 60 mL/min
- Bilirubin ≤ 1.0 times upper limit of normal (ULN)
- Alkaline phosphatase ≤ 2.5 times ULN
- AST ≤ 1.5 times ULN
- INR normal
- PTT ≤ 1.0 times ULN
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 12 months after completion of study therapy
- FEV_1 ≥ 1.5 L OR ≥ 75% of the reference value
- Must be compliant and geographically proximal for staging and follow-up
- Considered operable (i.e., appropriate organ functions and ability to undergo general anesthesia)
- No other malignancies within the past 5 years except nonmelanomatous skin cancer or adequately treated carcinoma in situ of the cervix
No severe or uncontrolled cardiovascular disease, including any of the following:
- NYHA class III-IV congestive heart failure
- Unstable angina pectoris
- Myocardial infarction within the past 12 months
- Significant arrhythmias
- No psychiatric disorder precluding understanding of information on trial related topics, giving informed consent, and answering questionnaires
- No active uncontrolled infection
- No serious underlying medical condition that, in the opinion of the investigator, could impair the ability of the patient to participate in the trial (e.g., uncontrolled diabetes mellitus or active autoimmune disease)
- No preexisting peripheral neuropathy > grade 1
- No definite contraindications for the use of corticosteroids and antihistamines as premedication
- No known hypersensitivity to trial drugs or hypersensitivity to any other component of the trial drugs
PRIOR CONCURRENT THERAPY:
- No prior chemotherapy or radiotherapy to the chest
- At least 30 days since prior treatment in another clinical trial
- No concurrent drugs contraindicated for use with the trial drugs
- No other concurrent anticancer treatments
- No other concurrent experimental drugs or investigational treatments
Sites / Locations
- Landeskrankenhaus
- Universitätsklinik für Innere Medizin I
- Krankenhaus Barmherzige Schwestern Linz
- Krankenhaus der Elisabethinen Linz GmbH
- Universitätsklinikum der PMU Salzburg
- Klinikum Wels-Grieskirchen GmbH
- Universitätsklinik für Innere Medizin
- Hôpital Avicenne
- Centre Hospitalier Général
- Hôtel Dieu Estaing
- CHU Le Bocage
- Centre Georges-François Leclerc
- Centre Bourgogne
- CHRU de Lille
- Clinique François Chénieux
- CHU la TIMONE
- CH Régional de la Source
- CH Saint Jean
- Hôpital Haut Leveque
- CHU
- CHU de Saint Etienne - Hôpital Nord
- Clinique Ste Anne
- Hôpital Purpan
- Charite University Hospital - Campus Virchow Klinikum
- Universitaetsklinikum Duesseldorf
- Kliniken Essen - Mitte
- Universitaetsklinikum Freiburg
- SLK-Kliniken Heilbronn GmbH
- Klinikum Herford
- Klinikum Ludwigsburg
- Universitaetsklinikum Giessen und Marburg GmbH
- Klinikum der Universitaet Muenchen - Grosshadern Campus
- Staedtisches Klinikum Solingen
- Klinikum Stuttgart - Katharinenhospital
- Universitaetsklinikum Tuebingen
- Szent Laszlo Korhaz
- Hirslanden Klinik Aarau
- Kantonsspital Aarau
- Kantonsspital Baden
- St. Claraspital AG
- Universitaetsspital-Basel
- Inselspital Bern
- Kantonsspital Bruderholz
- Kantonsspital Graubuenden
- Hopital Cantonal Universitaire de Geneve
- Centre Hospitalier Universitaire Vaudois
- Kantonsspital Liestal
- Kantonsspital Olten
- Hôpital du Valais (RSV)-CHCVs
- Kantonsspital - St. Gallen
- Regionalspital
- Ospedale Italiano
- Kantonsspital Winterthur
- Onkozentrum Klinik im Park
- Klinik Hirslanden
- City Hospital Triemli
- UniversitaetsSpital Zuerich
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Additional immunotherapy (cetuximab)
Without additional immunotherapy
All patients in the experimental arm will be given additional immunotherapy (cetuximab) during cycles 1 and 2, during RT and after surgery.
Standard therapy without immunotherapy (cetuximab).