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A 3-Year Overall Survival Update From a Phase 2 Study of Chemoselection With DCF and Subsequent Conversion Surgery for Locally Advanced Unresectable Esophageal Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A multicenter phase 2 trial analysed chemoselection with docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy (ICT) and subsequent conversion surgery (CS) for locally advanced unresectable esophageal cancer. This study presents updated 3-year analyses to further characterize the impact of DCF-ICT followed by CS.

Methods

Esophageal cancer patients with clinical T4 disease, unresectable supraclavicular lymph node metastasis, or both were eligible for this study. The treatment starts with DCF-ICT, followed by CS if the cancer is resectable, or by concurrent chemoradiation if it is not resectable. This updated analysis presents 3-year overall survival (OS), 3-year progression-free survival (PFS), and pattern of relapse.

Results

The median follow-up period for the patients surviving without death was 39.3 months. The estimated 1-year OS was 66.7%, and the lower limit of the 80% confidence interval (CI) was 54.6%. The estimated 3-year OS was 46.6% (95% CI 34.2–63.5%). The OS for the patients who underwent R0 resection (n = 19) was significantly longer than for those who did not (3-year OS: 71.4% vs. 30.1%). The estimated 1-year PFS was 50.6%, and the 3-year PFS was 39.6%. The PFS for R0 was significantly longer than for non-R0 (3-year PFS: 61.3% vs 25.0%). Recurrence or progression at the primary site was observed in 31% of the non-R0 group. The rate of distant metastasis did not differ significantly between the non-R0 and R0 groups (21% vs 16%).

Conclusions

Long-term follow-up evaluation confirmed that DCF chemoselection aimed at CS is feasible and promising in terms of survival for patients with locally advanced esophageal cancer.

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Acknowledgment

This study was supported by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare. This study also was supported in part by the National Cancer Center Research and Development Fund (26-A-4). The authors are grateful to Dr. Takashi Ichimura, Dr. Mariko Ogura, Dr. Daisuke Takahari (Cancer Institute Hospital of Japanese Foundation for Cancer Research), Dr. Fumihiko Kato, Dr. Satoshi Matsuda (Keio University School of Medicine), Dr. Natsuko Okita, Dr. Satoru Iwasa, Dr. Atsuo Takashima, Dr. Yoshitaka Honma (National Cancer Center Hospital), Dr. Takako Yoshii (Saitama Cancer Center), Dr. Akiko Todaka, Dr. Nozomu Machida, Dr. Takahiro Tsushima (Shizuoka Cancer Center), Dr. Keiko Minashi (Chiba Cancer Center), Dr. Tetsushi Terasawa, Dr. Hitoshi Nishitani (Osaka Medical College), Dr. Kazuhiko Yamada (National Center for Global Health and Medicine), and Dr. Kentaro Kawakami (Tochigi Cancer Center) for help with the patient enrollment. The authors are also grateful to Dr. Hiroyasu Igaki for useful advice.

Author information

Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Tomoya Yokota MD, PhD

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

    Ken Kato MD, PhD

  3. Division of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan

    Yasuo Hamamoto MD

  4. Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Yasuhiro Tsubosa MD, PhD

  5. Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Hirofumi Ogawa MD

  6. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan

    Yoshinori Ito MD

  7. Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan

    Hiroki Hara MD

  8. Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan

    Takashi Ura MD

  9. Department of Gastroenterology, National Cancer Center Hospital East, Chiba, Japan

    Takashi Kojima MD

  10. Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Keisho Chin MD

  11. Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan

    Shuichi Hironaka MD

  12. Cancer Chemotherapy Center, Osaka Medical College Hospital, Osaka, Japan

    Takayuki Kii MD, PhD

  13. Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan

    Yasushi Kojima MD

  14. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Yasunori Akutsu MD, PhD

  15. Department of Surgery, Tochigi Cancer Center, Tochigi, Japan

    Hisayuki Matsushita MD

  16. Department of Medical Oncology, Tochigi Cancer Center, Tochigi, Japan

    Kentaro Kawakami MD, PhD

  17. Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Japan

    Keita Mori PhD

  18. Clinical Data Management, Clinical Research Data Center, National Cancer Center Hospital, Tokyo, Japan

    Takashi Makiuchi & Rie Nagumo

  19. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Yuko Kitagawa MD, PhD, FACS

Authors
  1. Tomoya Yokota MD, PhD
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  2. Ken Kato MD, PhD
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  3. Yasuo Hamamoto MD
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  4. Yasuhiro Tsubosa MD, PhD
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  5. Hirofumi Ogawa MD
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  6. Yoshinori Ito MD
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  7. Hiroki Hara MD
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  8. Takashi Ura MD
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  9. Takashi Kojima MD
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  10. Keisho Chin MD
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  11. Shuichi Hironaka MD
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  12. Takayuki Kii MD, PhD
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  13. Yasushi Kojima MD
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  14. Yasunori Akutsu MD, PhD
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  15. Hisayuki Matsushita MD
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  16. Kentaro Kawakami MD, PhD
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  17. Keita Mori PhD
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  18. Takashi Makiuchi
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  19. Rie Nagumo
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  20. Yuko Kitagawa MD, PhD, FACS
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Corresponding author

Correspondence to Tomoya Yokota MD, PhD.

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Fig. S1

CONSORT flow diagram. CR, complete response; CRT, chemoradiotherapy; CS, conversion surgery; DCF, docetaxel plus cisplatin and 5-fluorouracil; PD, progressive disease; RT, radiotherapy *23.5% (4/17) of the patients who were ineligible for CS achieved CR after completion of CRT. (TIFF 71 kb)

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Yokota, T., Kato, K., Hamamoto, Y. et al. A 3-Year Overall Survival Update From a Phase 2 Study of Chemoselection With DCF and Subsequent Conversion Surgery for Locally Advanced Unresectable Esophageal Cancer. Ann Surg Oncol 27, 460–467 (2020). https://doi.org/10.1245/s10434-019-07654-8

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  • DOI: https://doi.org/10.1245/s10434-019-07654-8

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