Clinical efficacy of neoadjuvant chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma

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Objective To explore the efficacy of neoadjuvant chemoradiotherapy (CRT) followed by surgery for locally advanced esophageal squamous cell carcinoma ( ESCC), and to investigate the correlation between a clinical complete response ( cCR) and a pathologic complete response ( pCR). Methods One hundred and fifty-eight patients with locally advanced thoracic ESCC from 2001 to 2013 were retrospectively analyzed. All patients received concurrent chemoradiotherapy followed by surgery. Platinum-based chemotherapy regimens were adopted in chemotherapy and a prescribed dose of 40 Gy in 20 fractions, 5 fractions per week, was used in radiotherapy. The overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier method, and pairwise comparisons and univariate prognostic analyses were performed using the log-rank test. Multivariable prognostic analyses were performed using the Cox regression model. Results The pCR rate was 41. 1% in all patients. After the treatment with neoadjuvant CRT, 32(72. 7% ) out of 44 patients with a cCR had a pCR, but only 33(28.9%) out of 114 patients with a non-cCR had a pCR (P = 0. 000 ). The sensitivity, specificity, positive predictive value, and negative predictive value of a cCR in predicting a pCR were 49.2%, 87.1%, 72.7%, and 71. 1%, respectively. The 3-year sample size was 91. The 3-year OS and DFS rates in all patients were 53. 9% and 48.6%, respectively. Patients with a cCR had significantly higher 3-year OS and DFS rates than those with a non-cCR (P =0. 012;P =0. 026), while patients with a pCR had significantly higher 3-year OS and DFS rates than those with a non-pCR (P =0. 000 ; P = 0. 000). The multivariate analyses demonstrated that the pathologic response after CRT and chemotherapy regimen were the influencing factors for OS. The most common grade acute adverse reaction was leucopenia (34.2%). Conclusions With a high pCR rate and tolerable adverse reactions, neoadjuvant CRT followed by surgery is a safe and effective option for locally advanced ESCC. The cCR rate after CRT is closely correlated with the pCR and OS rates. Key words: Esophageal neoplasms/neoadjuvant chemoradiotherapy; Clinical complete response; Pathologic complete response; Prognosis