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.
The impact of the nodal status on the overall survival of non-surgical patients with esophageal squamous cell carcinoma
