91 Background: Neoadjuvant chemoradiotherapy (nCRT) combined with surgery has been recommended as the standard treatment for locally advanced esophageal cancer in western countries. However, in clinical practice, neoadjuvant chemotherapy (nCT), rather than nCRT, is preferred for a large cohort of patients with locally advanced esophageal squamous cell carcinoma (ESCC) for fear of increasing the odds of postoperative morbidity in China. The aim of this study is to compare the clinical efficacy of nCRT and nCT in terms of postoperative morbidity, tumor pathology and survival in patients with locally advanced ESCC. Methods: A total of 111 patients with locally advanced ESCC (T2-4N0-1M0) received neoadjuvant treatment at our institution from January 2009 through January 2014.Among these patients, 53 cases received one cycle of neoadjuvant chemotherapy with concurrent radiotherapy while the remaining 58 cases received two cycles of neoadjuvant chemotherapy only before surgery. Results: pCR was observed in 15 patients in nCRT group (28.3%) and 8 patients in nCT group (13.8%, P= 0.060). Postoperative morbidity was 32.1% in nCRT group and 37.9% in nCT group (P= 0.660). Disease-free survival rates at 1, 2, 3 years were 73.1%, 66.7%, 53.6% in nCRT group and 73.7%, 60.4%, 52.2% in nCT group (P= 0.848). Overall survival rates at 1, 2, 3 years were 88.5%, 78.0%, 59.5% in nCRT group and 89.5%,72.9% and 56.2% in nCT group(P= 0.749). No significant differences were found in recurrence rate between two groups (P= 0.836). Conclusions: Neoadjuvant CRT may achieve higher pCR rate than neoadjuvant CT without increasing the odds of postoperative morbidity. Both neoadjuvant CRT and CT can prolong survival in patients with locally advanced ESCC. Further study is needed to prove which one is better.
166TiP Pembrolizumab combined with neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy followed surgery for locally advanced esophageal squamous cell carcinoma: Protocol for a multi-center, prospective, randomized-controlled, phase III clinical study (Keystone-002)
