Feasibility study of neo-chemoradiotherapy for stage IB/II/III esophageal squamous cell carcinoma: A 4-year follow up

Abstract

Introduction: Neoadjuvant chemotherapy with CDDP plus 5‐FU is considered the standard treatment for stage IB/II/III esophageal squamous cell carcinoma (ESCC) in Japan. However, patient survival remains unsatisfactory. Objectives: We conducted a feasibility study of neoadjuvant chemoradiotherapy (NeoCRT) with CDDP plus 5‐FU and elective nodal irradiation in patients with stage IB/II/III ESCC. Aim of follow up study is to clarify the long term outcome and site of recurrence. Material and Methods: Eligibility criteria included clinical stage IB/II/III ESCC, a PS of 0‐1, and age of 20‐75 years. Chemotherapy consisted of 2 courses of 5‐FU (1000mg/m2, days 1‐4) and CDDP (75mg/m2, day 1), with a 4week interval. Radiotherapy was concurrently administered to a total dose of 41.4Gy in 23 fractions. After completion of CRT, transthoracic esophagectomy with extensive lymphadenectomy (>D2) was performed. Results: Thirty‐three patients (pts) were enrolled in this study between July 2010 and June 2011, and 2 were determined to be ineligible. Characteristics of the 31 eligible patients included a median age of 63 years (range, 40‐73 years), male/female ratio of 28/3, PS 0/1 distribution of 19/12, and cStage IIA/IIB/III distribution of 2/10/19. In total, 31 patients (100%) underwent NeoCRT, and 25 (81%) underwent surgery; 1patient (3%) did not undergo surgery due to disease progression. Among the patients who underwent surgery, there was 1 treatment‐related death. After 54.3 month of follow up time, 9 patients had recurred in regional only (2pts) and with any distant lesion (7pts). The 3‐ year recurrence free and overall survival rates were 60.9% and 70.8%, respectively. No ≥grade3 late toxicities were seen. Conclusions: NeoCRT with CDDP plus 5‐FU and elective nodal radiation showed better survival than neoadjuvant chemotherapy and found to be highly promising. A randomized, controlled trial (JCOG1109) comparing NeoCRT with neoadjuvant chemotherapy is ongoing.