RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing
so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor
cells. Combining radiation therapy with chemotherapy may kill more tumor cells.
PURPOSE: Phase I trial to study the effectiveness of combination chemotherapy and radiation
therapy in treating patients with cancer of the esophagus.
OBJECTIVES: I. Estimate the maximum tolerated dose and recommend a phase II dose for
paclitaxel (TAX) when administered as a 96-hour intravenous infusion with a weekly fixed
dose of intravenous cisplatin (CDDP) during concurrent radiotherapy for patients with
localized esophageal cancer. II. Estimate the response rate of patients treated with 2
courses of TAX/CDDP induction chemotherapy and the complete response rate of patients
treated with TAX/CDDP and concurrent radiotherapy. III. Describe the toxic effects of
TAX/CDDP prior to and during radiotherapy. IV. Describe the pharmacokinetics of TAX as a
continuous infusion (CI) over 96 hours. V. Evaluate, by flow cytometry, the ability of CI
TAX to block esophageal cancer cells in the G2-M phase of the cell cycle.
OUTLINE: After the MTD of TAX is reached on Part A, new patients are entered on Part B. The
following acronyms are used: CDDP Cisplatin, NSC-119875 EBRT External-beam radiotherapy TAX
Paclitaxel (Bristol-Myers), NSC-125973 PART A: Radiotherapy plus 2-Drug Combination
Chemotherapy. EBRT using megavoltage equipment (>/= 10 MV recommended; electron boost
allowed for subclavicular fossae); plus TAX/CDDP. PART B: 2-Drug Combination Induction
Chemotherapy followed by Radiotherapy plus 2-Drug Combination Chemotherapy. TAX/CDDP;
followed by EBRT as in Part A; plus TAX/CDDP.
PROJECTED ACCRUAL: At least 3 patients/dose will be entered on Part A (up to 24 patients)
and 3-6 patients on Part B.
DISEASE CHARACTERISTICS: Histologically confirmed epidermoid carcinoma or adenocarcinoma
of the esophagus eligible for potentially curative radiotherapy Disease in one of the
following categories: Newly diagnosed Locoregional failure after prior resection with
curative intent Positive microscopic margin after palliative resection of all gross
disease Disease clinically limited to esophagus T 1-4, any N, M0 Gastroesophageal junction
tumor allowed No positive pleural, pericardial, or peritoneal cytology No tracheobronchial
invasion on bronchoscopy, including tracheoesophageal fistula
PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 60-100%
Hematopoietic: WBC more than 4,000/mm3 Platelet count at least 150,000/mm3 Hepatic:
Bilirubin no greater than 1.5 mg/dL Renal: Creatinine no greater than 1.5 mg/dL OR
Creatinine clearance at least 65 mL/min per 1.73 square meters Cardiovascular: No NYHA
class 3/4 status No cerebral vascular disease No hypertension Other: No severe
uncontrolled diabetes No uncontrolled infection No other medical condition that precludes
treatment No mental status abnormality that precludes comprehension of or compliance with
treatment No active cancer arising at another primary site other than basal cell carcinoma
of the skin or in situ cervical carcinoma
PRIOR CONCURRENT THERAPY: No prior chemotherapy or radiotherapy