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Phase II feasibility study of preoperative concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil and elective lymph node irradiation for clinical stage II/III esophageal squamous cell carcinoma

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Abstract

Background

Preoperative chemoradiotherapy (CRT) is a standard treatment for stage II/III esophageal cancer. Preoperative chemotherapy is also considered a standard treatment for stage II/III esophageal squamous cell carcinoma (ESCC) in patients who undergo radical lymph node dissection. We conducted a feasibility study of preoperative CRT with cisplatin plus 5-fluorouracil (CF) and elective lymph node irradiation followed by esophagectomy with radical lymph node dissection in patients with stage II/III ESCC.

Methods

Patients with clinical stage II/III, excluding T4, ESCC (International Union Against Cancer TNM classification system, 6th edition) were eligible. Chemotherapy comprised two courses of CF infusion repeated after 4-weeks. Radiation therapy was concurrently administered to the primary tumor, metastatic lymph nodes, and regional lymph nodes at a dose of 41.4 Gy. After the completion of CRT, transthoracic esophagectomy with 2–3 fields lymphadenectomy was performed. The primary endpoint was the completion rate of protocol treatment with R0 resection.

Results

Thirty-one eligible patients were enrolled. During CRT, the most common grade 3 or 4 toxicities were leukopenia (65%), neutropenia (65%), anemia (13%), thrombocytopenia (13%), febrile neutropenia (13%), anorexia (16%), esophagitis (16%) and hyponatremia (16%). Thirty patients (96.8%) underwent surgery. One patient received palliative chemotherapy because of appearance of lung metastasis during CRT. The completion rate of protocol treatment was 93.5% (29/31). There was one treatment-related death after surgery. Pathological complete response was achieved in 42% (13/30).

Conclusion

Preoperative CRT with CF and elective lymph node irradiation showed an acceptable toxicity and promising activity especially in ESCC.

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Acknowledgements

We express our appreciation to Mr. Nagai, Ms. Tada, Ms. Usami, Ms. Sakamoto, Ms. Ayabe, and Ms. Shinogi for data collection and management.

Funding

This study was also supported by National Cancer Center Research and Development Funds (23-A-16, 23-A-18 and 26-A-4).

Author information

Authors and Affiliations

  1. Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan

    Jun Hashimoto & Ken Kato

  2. Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan

    Yoshinori Ito

  3. Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan

    Hiroyasu Igaki

  4. Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Takashi Kojima

  5. Radiation Oncology Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Tetsuo Akimoto

  6. Esophageal Surgery Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Hiroyuki Daiko

  7. School of Medicine, Keio Cancer Center, Keio University, Tokyo, Japan

    Yasuo Hamamoto

  8. Department of Surgery, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan

    Hisayuki Matsushita

  9. Department of Radiation Oncology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan

    Susumu Katano

  10. Department of Gastroenterology, Saitama Cancer Center, Ina, Saitama, Japan

    Hiroki Hara

  11. Division of Gastroenterological Surgery, Saitama Cancer Center, Ina, Saitama, Japan

    Yoichi Tanaka

  12. Department of Radiation Oncology, Saitama Cancer Center, Ina, Saitama, Japan

    Yoshihiro Saito

  13. Department of Global Clinical Research, Graduate School of Medicine, Chiba University, Chiba, Japan

    Kengo Nagashima

Authors
  1. Jun Hashimoto
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  2. Ken Kato
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  3. Yoshinori Ito
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  5. Tetsuo Akimoto
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  7. Yasuo Hamamoto
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  8. Hisayuki Matsushita
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  9. Susumu Katano
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  10. Hiroki Hara
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  11. Yoichi Tanaka
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  12. Yoshihiro Saito
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  13. Kengo Nagashima
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  14. Hiroyasu Igaki
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Corresponding author

Correspondence to Ken Kato.

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Hashimoto, J., Kato, K., Ito, Y. et al. Phase II feasibility study of preoperative concurrent chemoradiotherapy with cisplatin plus 5-fluorouracil and elective lymph node irradiation for clinical stage II/III esophageal squamous cell carcinoma. Int J Clin Oncol 24, 60–67 (2019). https://doi.org/10.1007/s10147-018-1336-x

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  • DOI: https://doi.org/10.1007/s10147-018-1336-x

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