Abstract
BackgroundThe improvement of survival outcomes and the reduction of toxicities for esophageal squamous cell carcinoma (SCC) are still needed. We conducted a pilot study of concurrent chemoradiotherapy with weekly docetaxel and cisplatin for the treatment of esophageal SCC with T4 and/or M1 lymph node metastasis (LNM) or locoregional recurrence.MethodsFifty-four patients with advanced thoracic esophageal SCC having a stage T4 tumor or M1 LNM and/or locoregional recurrence were enrolled. Docetaxel and cisplatin were both administered weekly at a dose of 25 mg/m2 5–6 times in total concurrently with a specific dose of radiation. The primary endpoint was overall survival (OS), and the secondary endpoints were progression-free survival (PFS), locoregional control and treatment-related toxicities.ResultsFrom October 2015 to December 2016, concurrent treatment with full-cycle docetaxel and cisplatin and radiotherapy was administered to 41 of 54 patients (75.9%). A total of 51 patients (94.4%) completed the radiation schedules. Twenty-one patients (44.4%) achieved a complete response, and 21 (44.4%) achieved a partial response after chemoradiotherapy. The median survival time was 18.2 months, and the median PFS time was 11.5 months. The 1-year and 3-year OS, locoregional control and PFS rates were 70.4, 80.6, 50.0 and 36.4%, 64.3, 31.5%, respectively. Grade 3 toxicities included neutropenia (13.0%), anemia (3.7%), thrombocytopenia (1.9%), fatigue (20.4%), anorexia (13.0%), esophagitis (11.1%), and pneumonitis (5.6%). Grade 4 neutropenia occurred in 16.7% of patients. Four patients (7.4%) died from grade 5 toxicities. There were no significant differences in both survival and grade 3 and higher toxicities between the newly diagnosed group and recurrent group.ConclusionsConcurrent chemoradiotherapy with weekly docetaxel and cisplatin is a well-tolerated and effective treatment regimen for esophageal SCC with T4 or M1 LNM and/or locoregional recurrence. Clinical trials with larger sample size and comparisons with conventional fluorouracil and cisplatin regimens are needed.
Highlights
Esophageal cancer is the fourth most common cause of cancer-related death in China [1]
The outcome of CRT is still unsatisfactory (5-year survival is only 27% according to RTOG 85–01) [4], and 40% of patients treated with concomitant CRT suffer tumor persistence or locoregional recurrence [6]
Patients The criteria for inclusion were: (1) 18–75 years of age; (2) histologically verified squamous cell carcinoma; (3) SCC that was considered unsuitable for surgical resection based on a multidisciplinary team opinion; (4) ECOG performance status of 0 or 1; (5) adequate organ function to ensure the safety of treatment; (6) life expectancy more than 6 months; (7) use of adequate contraception
Summary
Esophageal cancer is the fourth most common cause of cancer-related death in China [1]. In Eastern countries, squamous cell carcinoma (SCC) is still the predominant histological subtype of esophageal cancer [2], and a considerable number of patients have already lost the opportunity for treatment with surgery at the time of diagnosis. For patients with nonsurgical esophageal cancer, definitive concurrent chemoradiotherapy (CRT) is the standard treatment, and combined chemotherapy with 5fluorouracil and cisplatin (PF) is the most commonly used regimen [3,4,5]. The improvement of survival outcomes and the reduction of toxicities for esophageal squamous cell carcinoma (SCC) are still needed. We conducted a pilot study of concurrent chemoradiotherapy with weekly docetaxel and cisplatin for the treatment of esophageal SCC with T4 and/or M1 lymph node metastasis (LNM) or locoregional recurrence
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