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Past
The standard treatment of borderline resectable esophageal squamous cell carcinoma (BR-ESCC) patients is controversial. Recently, the results of the COSMOS trial1,2 showed that induction chemotherapy followed by surgery was promising for patients with BR-ESCC. Patients who underwent R0 resection surgery showed a better prognosis than those who did not. We conducted the NEOCRTEC-1601 clinical trial3,4 to assess the safety and efficacy of induction chemotherapy followed by surgery for BR-ESCC.
Present
Our results4 showed that R0 resection was achieved in 53.2% of patients, among whom 8.5% achieved pCR. Patients who received surgery and achieved R0 resection had significantly improved overall survival (OS) and progression-free survival. The 3-year OS rate of patients who underwent R0 resection was 65.4%.
Future
In our view, R0 resection may be the independent prognosis factor of BR-ESCC. However, randomized controlled studies are needed to confirm our views. We plan to conduct subsequent studies in our center that will be aimed at exploring new regimens (study currently underway: NEOCRTEC-2001, ClinicalTrials.gov identifier NCT04548440) to improve the R0 resection rate and compare the prognostic efficacy of different treatment strategies.
References
Yokota T, Kato K, Hamamoto Y, et al. Phase II study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancer. Br J Cancer. 2016;115(11):1328–34.
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. 2020;27(2):460–7.
Wang Z, Hu M, Hu Y, et al. Paclitaxel plus cisplatin and 5-fluorouracil induction chemotherapy for locally advanced borderline-resectable esophageal squamous cell carcinoma: a phase II clinical trial. Esophagus. 2022;19(1):120–8.
Wu J-D, Wang Z-Q, Li Q-Q, et al. A 3-year survival update from a phase 2 study of paclitaxel plus cisplatin and 5-fuorouracil induction chemotherapy for locally advanced borderline-resectable esophageal squamous cell carcinoma: the NEOCRTEC-1601 clinical trial. Ann Surg Oncol. 2023. https://doi.org/10.1245/s10434-023-14513-0
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Hong, Y. ASO Author Reflections: Treatment Strategies for Locally Advanced Borderline Resectable Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 31, 896 (2024). https://doi.org/10.1245/s10434-023-14549-2
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DOI: https://doi.org/10.1245/s10434-023-14549-2