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Induction Chemotherapy for Locally Advanced Esophageal Cancer

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Abstract

Background

Concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (EC), and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR).

Methods

We assembled a retrospective analysis of patients (pts) diagnosed with locally advanced EC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients’ characteristics, tumor variables, and treatment outcomes were evaluated. The Kaplan-Meier method was used to estimate overall survival and the Cox proportional hazard model to evaluate prognostic factors.

Results

One hundred and three patients were studied, with a median age of 62 years (range 37–84). Seventy-five patients (73%) were male, 67 (65%) had squamous cell carcinoma, and 31 (30%) had adenocarcinoma. Forty-three patients (41.7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum chemotherapy (90%), and the median number of cycles was 2. All patients received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 patients (91%). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S groups (p = 0.628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for time to treatment failure (TTF) (HR 0.35, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95%, p = 0.026).

Conclusions

Our data suggest that the addition of IC to standard CRT + S does not increase the pCR rate in locally advanced EC. No difference in OS was observed between pts. that received or not IC. Regardless of the treatment received, pts. achieving a pCR presented improved TTF.

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Authors and Affiliations

  1. Instituto do Câncer do Estado de São Paulo, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

    Guilherme Harada, Renata Rodrigues da Cunha Colombo Bonadio, Frederico Cantarino Cordeiro de Araújo, Carolina Ribeiro Victor, Rubens Antonio Aissar Sallum, Ulysses Ribeiro Junior, Ivan Cecconello, Flávio Roberto Takeda & Tiago Biachi de Castria

  2. Centro de Oncologia, Hospital Sírio-Libanês, Sao Paulo, Brazil

    Guilherme Harada & Tiago Biachi de Castria

  3. Division of Digestive Surgery - Department of Gastroenterology, São Paulo State Cancer Institute - ICESP-HCFMUSP, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

    Rubens Antonio Aissar Sallum, Ulysses Ribeiro Junior, Ivan Cecconello & Flávio Roberto Takeda

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  1. Guilherme Harada
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  2. Renata Rodrigues da Cunha Colombo Bonadio
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  3. Frederico Cantarino Cordeiro de Araújo
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Correspondence to Guilherme Harada.

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Harada, G., Bonadio, R.R.d.C., de Araújo, F.C.C. et al. Induction Chemotherapy for Locally Advanced Esophageal Cancer. J Gastrointest Canc 51, 498–505 (2020). https://doi.org/10.1007/s12029-019-00266-1

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