Neoadjuvant Chemoradiotherapy with Cisplatin Plus Fluorouracil for Borderline Resectable Esophageal Squamous Cell Carcinoma

Abstract

Background

The optimal treatment strategy for patients with borderline resectable (BR) esophageal squamous cell carcinoma (ESCC), in which tumors grow very close to the adjacent vital organs, remains unclear. This study evaluated the efficacy of neoadjuvant chemoradiotherapy (NACRT) with cisplatin plus fluorouracil (CF) and irradiation (40 Gy) for these patients.

Methods

The study cohort included 50 patients with BR-ESCC who received NACRT as the initial treatment and were allocated to one of two groups: patients who achieved curative resection (R0 group) or those who did not (Non-R0 group). The overall survival (OS), relapse-free survival (RFS), and pre-therapeutic predictive factors for Non-R0 were evaluated.

Results

Among the 50 patients, 22 (44%) achieved curative resection clinically. The median OS was significantly better in the R0 group than in the Non-R0 group (2.4 vs 0.8 years; hazard ratio [HR], 0.29; 95% confidence interval [CI], 0.12–0.67; p < 0.01). The independent predictive factors before NACRT for Non-R0 were higher serum SCC antigen level (p < 0.01) and clinical nodal involvement (p = 0.02). In addition, OS was significantly worse for the patients with higher levels of serum SCC antigen than for those with lower levels (p < 0.01).

Conclusions

Curative resection was achieved for about 40% of the patients who received NACRT for BR-ESCC. Therefore, NACRT could be a useful neoadjuvant treatment option for BR-ESCC. However, a higher serum SCC antigen level before NACRT is predictive of treatment failure and poor survival.

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Correspondence to Akihiko Okamura MD, PhD.

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All authors declare no conflicts of interests for this article. Conflicts of interests outside this work are as follows; Kensei Yamaguchi played Consulting or Advisory Role for Bristol-Myers Squibb Japan and Daiichi Sankyo, and received Speakers’ Bureau from Chugai Pharma, Merck Serono, Bristol-Myers Squibb Japan, Takeda, Taiho Pharmaceutical, Lilly, Ono Pharmaceutical, Sanofi and Daiichi Sankyo. Kensei Yamaguchi’s institution (Department of Gastroenterological Medicine, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research) received research funding from MSD Oncology, Ono Pharmaceutical, Dainippon Sumitomo Pharma, Taiho Pharmaceutical, Daiichi Sankyo, Lilly, Gilead Sciences, Yakult Honsha, Chugai Pharma, Boehringer Ingelheim and Eisai.

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Suzuki, T., Okamura, A., Watanabe, M. et al. Neoadjuvant Chemoradiotherapy with Cisplatin Plus Fluorouracil for Borderline Resectable Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 27, 1510–1517 (2020). https://doi.org/10.1245/s10434-019-08124-x

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