Abstract
BackgroundSquamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females. Surgery alone is associated with poor long-term survival. Neoadjuvant chemoradiation and perioperative chemotherapy without radiation have been tried to improve survival rates.MethodsWe retrospectively evaluated the neoadjuvant chemotherapy in forty-eight patients with non-metastatic, non-cervical squamous cell carcinoma of the esophagus with a docetaxel-based three-drug regimen to improve complete pathological response rates.ResultsThe median age of presentation was 52 years, with male preponderance. All the patients received three cycles of docetaxel-cisplatin-fluorouracil-based chemotherapy. A complete pathological response to neoadjuvant chemotherapy was seen in 8 patients (17%). Rates of grade 3 hematological toxicities were seen in 12% of patients, with no observed grade 4 toxicity. The most common non-hematological toxicity was grade 3 alopecia (seen in 40%) and grade 2 nausea/vomiting in 8% of patients. At a median follow-up of 26.5 months, 2-year survival for the patients receiving chemotherapy and surgery is 66%.ConclusionsPreoperative chemotherapy with a taxane-based triple-drug regimen is a reasonable approach in squamous cell carcinoma of the esophagus, associated with improvement in complete pathological response rates, increases complete resection rates, with manageable toxicity.
Highlights
Squamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females
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Demography (Table 1) Of the total 2450 cases of esophageal cancers, 48 patients with Squamous cell carcinoma of the esophagus (SCEC) were eligible for the study analysis (Fig. 1)
Summary
Squamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females. In a Japanese Study ( JCOG 9907) which compared neo-adjuvant chemotherapy (NACT) with postoperative chemotherapy in the treatment of stage II/III esophageal squamous cell carcinoma, preoperative chemotherapy with cisplatin and 5-fluorouracil (5-FU) followed by surgery was shown to improve OS (5-year survival—55%) without additional serious adverse events [10]. Studies in advanced gastric carcinoma and squamous cell carcinoma of the head and neck region have already shown improved response and survival rates to triplet docetaxel, cisplatin, and 5-fluorouracil (DCF)based NACT [11–13]. Chan’s meta-analysis showed that complete pathological response (pCR) to NACCRT is higher than NACT [14] It has been demonstrated in various randomized trials that higher pCR rates translate into a survival benefit [15, 16]. In this analysis, the NACT regimen comprised of two drugs (cisplatin and 5-fluorouracil). Our present study sought to investigate the pCR rates to DCF-based NACT in patients with SCEC
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