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Therapeutic strategy aiming at R0 resection for borderline-resectable esophageal squamous cell carcinoma using induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil

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Abstract

Objective

Treatment for borderline resectable (cT3br) esophageal squamous cell carcinoma (SCC) is currently undefined. This study aimed to analyze the outcome of treatment strategies including induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) against T3br esophageal SCC.

Methods

A total of 32 patients with cT3br esophageal SCC enrolled in this study were treated with two cycles of DCF induction therapy.

Results

The overall response rate to DCF induction therapy was 62.5%, while the disease control rate was 93.8% (complete response (CR), three; partial response (PR), 17; stable disease (SD), 10; progressive disease (PD), 2). After DCF induction chemotherapy, 27 patients underwent conversion surgery (CS) and five patients underwent definitive chemoradiotherapy (CRT). Out of 27 patients who underwent CS, 17 underwent transthoracic esophagectomy and 10 underwent thoracoscopic esophagectomy. Anastomotic leakage occurred in five patients (18.5%) and pneumonia in four (14.8%). Recurrent laryngeal nerve paralysis and arrhythmia were observed in two patients (7.4%). The R0 resection rate was 81.5%. Among the five patients who underwent definitive CRT, only one patient (20.0%) achieved CR. Two patients (40.0%) had PR and two (40.0%) had PD. Salvage esophagectomy was performed in one patient after definitive CRT. The 1-, 3-, and 5-year overall survival rates were 75.0, 50.6, and 46.4%, respectively, whereas the 1-, 3-, and 5-year disease-free survival rates were 54.9, 38.8, and 38.8%, respectively.

Conclusion

DCF induction therapy and subsequent CS or definitive CRT are promising treatment strategies for cT3br esophageal SCC.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 KitakobayashiShimotsuga-gun, Mibu-machi, Tochigi, 321-0293, Japan

    Masanobu Nakajima, Hiroto Muroi, Maiko Kikuchi, Tsukasa Kubo, Noboru Inoue, Masatoshi Nakagawa, Shinji Morita & Kazuyuki Kojima

  2. Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, 880 KitakobayashiShimotsuga-gun, Mibu-machi, Tochigi, 321-0293, Japan

    Masanobu Nakajima, Hiroto Muroi, Maiko Kikuchi, Tsukasa Kubo, Noboru Inoue, Keisuke Ihara, Masatoshi Nakagawa, Shinji Morita, Takatoshi Nakamura & Kazuyuki Kojima

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  1. Masanobu Nakajima
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  2. Hiroto Muroi
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Contributions

Study conception, design, data analysis, and interpretation: NM, MH, KM, IK, and NM. Clinical data acquisition: IN, KT. Precision management: MS, NT, KK.

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Correspondence to Masanobu Nakajima.

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Nakajima, M., Muroi, H., Kikuchi, M. et al. Therapeutic strategy aiming at R0 resection for borderline-resectable esophageal squamous cell carcinoma using induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil. Gen Thorac Cardiovasc Surg 71, 584–590 (2023). https://doi.org/10.1007/s11748-023-01934-7

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