For localized esophageal cancer in patients with preexisting neuropathy, what do you use concurrently with radiation therapy?

I would probably start with low-dose carboplatin and paclitaxel as done in the CROSS trial, and monitor carefully for worsening neuropathy with weekly assessment. As the doses are low and the duration of therapy limited to only 5 weeks, we may not see much worsening. In CROSS, there was 15% neurotoxicity (not specified) of any grade and no G3/G4 neurotoxicity, but of course, that does not apply to patients with pre-existing neuropathy.

If the neuropathy is severe and/or the patient unwilling to risk further worsening, continuous infusion 5-FU (starting at 225 mg/m2 per 24 hr) is not unreasonable; and while capecitabine may work as well, I am always concerned about the ability of patients with esophageal cancer to swallow large pills. Radioth...