PS02.100: ASSOCIATION BETWEEN RESPONSES OF NEOADJUVANT DOCETAXEL PLUS CISPLATIN AND FLUOROURACIL (DCF) CHEMOTHERAPY AND SURVIVALS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA PATIENTS

Abstract Background For patients with stage II/III esophageal squamous cell carcinoma (ESCC), neoadjuvant chemotherapy with cisplatin and 5-fluorouracil followed by surgery has been regarded as a standard treatment in Japan based on the result of Japan Clinical Oncology Group trial (JCOG9907). However, the survival outcome of this doublet chemotherapy has been still unsatisfactory especially in stage III patients. Triplet-regimen, consisting of docetaxel plus cisplatin and 5-fluorouracil (DCF), showed good responses and survivals in some previous phase II studies, and therefore neoadjuvant DCF seems promising for more advanced stage. We adopted neoadjuvant DCF chemotherapy for patients with advanced ESCC. Methods We retrospectively analyzed 48 patients with ESCC treated with DCF as neoadjuvant chemotherapy from January 2013 to October 2017 in our hospital. All patients were in clinical T3–4a/N1–2/M0 or T1b-2 with bulky lymph metastasis based on the TNM classification 7th edition. DCF regimen consisted of i.v. docetaxel (60–70 mg/m2) on day 1 and cisplatin (60–70 mg/m2) on day 1, and continuous infusion of fluorouracil (600–700 mg/m2) on days 1–5. This regimen was repeated every 4 weeks. Results Forty-six patients (96%) completed 2 cycles of DCF. According to revised RECIST guideline, response rate was 29% (CR, 2; PR, 12; SD, 14; PD, 8; Non-CR/non-PD, 12). Forty-two patients except PD underwent surgery; R0 resection was achieved in 40 patients. Among 34 patients observed for more than 1 year after initial treatment, 1 year survival rate and overall survival time were 72.7% [95%CI: 49.1–86.7] and 20.1 months [95%CI: 9.4–30.6] in SD, Non-CR/non-PD and PD patients, while no patients died at the 1 year and did not reach median survival in CR and PR group (P = 0.001). Conclusion Survival of advanced ESCC patients was strongly associated with the clinical response to neoadjuvant DCF. It might be an indicator to select good candidates for surgical therapy. Disclosure All authors have declared no conflicts of interest.

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Evaluation of the Nodal Status in the 7th Edition of the UICC-TNM Classification for Esophageal Squamous Cell Carcinoma: Proposed Modifications for Improved Survival Stratification

Annals of Surgical Oncology ◽

10.1245/s10434-014-3696-4 ◽

2014 ◽

Vol 21 (9) ◽

pp. 2850-2856 ◽

Cited By ~ 38

Author(s):

Makoto Yamasaki ◽

Hiroshi Miyata ◽

Yasuhiro Miyazaki ◽

Tsuyoshi Takahashi ◽

Yukinori Kurokawa ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Tnm Classification ◽

Nodal Status ◽

7Th Edition

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PS02.086: ENDOSCOPIC RESPONSE EVALUATION OF NEOADJUVANT CHEMOTHERAPY CAN PREDICT PATHOLOGICAL RESPONSE AND SURVIVAL IN PATIENTS WITH ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.086 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 145-145

Author(s):

Yohei Nagai ◽

Naoya Yoshida ◽

Yoshifumi Baba ◽

Hideo Baba

Keyword(s):

Squamous Cell Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Response ◽

Squamous Cell ◽

Conflicts Of Interest ◽

Pathological Response ◽

Response Evaluation ◽

Radical Esophagectomy

Abstract Background To investigate the association between endoscopic response evaluation of neoadjuvant chemotherapy (NAC) with pathological response and survival in patients with esophageal squamous cell carcinoma (ESCC). Methods We retrospectively reviewed the medical records of patients with the aid of a prospectively entered database. One hundred and eleven consecutive patients with ESCC who underwent radical esophagectomy after NAC were included. All patients were divided into two groups according to endoscopic response after NAC: endoscopic non-responders in whom NAC was poorly or moderately effective, and endoscopic responders in whom NAC was highly effective or completely effective. The clinical response after NAC was evaluated according to the Response Evaluation Criteria in Solid Tumors (RECIST). Results The pretreatment clinical stage was IB in 5 patients (5%), II in 18 (16%), III in 72 (65%), and IV in 16 (14%). All patients received two courses of chemotherapy. Chemotherapy consisted of docetaxel, cisplatin (CDDP), and 5-fluorouracil (5-FU; the DCF regimen) in 82 patients (74%), and 5-FU and CDDP (FP) in 29 (26%). All patients underwent radical esophagectomy with 2- or 3-field lymph node dissection. The postoperative mortality and morbidity rates were 0.9% and 26%, respectively. Pathological stage (ypStage) was 0 in 1 patient (1%), I in 16 (14%), II in 31 (28%), III in 48 (43%), and IV in 15 (13%). Twenty-two patients (20%) were pathological responders, and this group of patients had better overall survival than pathological non-responders (P = 0.02). Pathological response was significantly correlated with tumor depth (cT) (P < 0.01), protruding type of tumor (P = 0.01) before NAC, and clinical response (P < 0.01) and endoscopic response (P < 0.01) after NAC. Of these clinical factors, clinical response and endoscopic response were significantly correlated with prognosis. Conclusion Endoscopic response after NAC can predict the pathological response and prognosis of patients who received NAC followed by surgery. Endoscopic findings are clinically significant to assess the response of NAC in patients with ESCC. Disclosure All authors have declared no conflicts of interest.

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Neoadjuvant chemotherapy using concurrent docetaxel/CDDP/5-FU (DCF) in esophageal squamous cell carcinoma and its excellent short-term prognosis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15122 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15122-e15122

Author(s):

Keishi Yamashita ◽

Natsuya Katada ◽

Chikatoshi Katada ◽

Kei Hosoda ◽

Hiomitsu Moriya ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Prognostic Factors ◽

Neoadjuvant Chemotherapy ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Pathologic Complete Response ◽

Progression Free Survival ◽

R0 Resection ◽

Prognostic Analysis

e15122 Background: Neoadjuvant chemotherapy (NAC) using 5-FU/CDDP (FP) followed by surgery is a standard treatment for esophageal squamous cell carcinoma (ESCC). However, this therapy often encountered progression during the early course of treatment. We are developing the novel NAC using Docetaxel/CDDP/5-FU (DCF). Methods: Thirty eight patients who underwent DCF NAC in cStage II/III ESCC was compared with the 41 counterparts treated by FP NAC. Docetaxel and CDDP were both given to 70-75 mg/ m2 with concurrent 5-FU at 750 mg/m2in 3 cycles. Median follow-up term of DCF NAC reached 18 months. Results: In DCF NAC, grade 3 adverse effects (AEs) were recognized in 97% (37/38), however non-hematological AEs exhibited 8% in stomatitis and 5% in anorexia, and completion rate of the DCF NAC was 86 %. In terms of PR+CR rate, DCF NAC was remarkably more excellent (33/38: 86.8%) than FP NAC (24/41: 58.5%)(P=0.0050). In DCF NAC therapy, 30 patients underwent surgery including 24 R0 esophagectomy, whereas another 8 patients selected definitive chemoradiation therapy. We experienced 3 patients with a pathologic complete response (ypCR)(10%) in DCF NAC. The 1st univariate prognostic analysis for progression free survival (PFS) among all the cases with NAC revealed that significant factors were R0 resection (P<0.0001), cT factor (P=0.0098), and NAC modality (P=0.1), and multivariate proportional hazard model identified these 3 factors as independent prognostic factors (IPFs). We then performed the 2nd stage multivariate prognostic analysis limited to R0 cases including pathologic factors for PFS. The univariate negative prognostic factors were FP NAC (P=0.0064), ypT3 (P=0.032), ypN3 (P=0.0017), ypv2/3 (P=0.0072), as well as cT3 (P=0.033), and multivariate analysis identified only NAC modality. DCF NAC was significantly associated with less frequency of ypT3 (P=0.019) and ypv2/3(P=0.013). Conclusions: Novel DCF NAC for ESCC demonstrated high response rates, and is promising for excellent survival in R0 cases, with acceptable feasibility. It improved the patient survival through downstage of the significant prognostic factors.

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