Comparison of radical surgery followed by adjuvant chemotherapy with radical surgery following neoadjuvant chemotherapy as initial treatment for patients with locally advanced thoracic esophageal squamous cell carcinoma.

Abstract

187 Background: Although radical surgery with neoadjuvant chemotherapy (NAC) is a standard therapy for locally advanced thoracic esophageal squamous cell carcinoma (ESCC) in response to the result of JCOG 9907 study in Japan, there was no significant difference in survival rate at adjuvant chemotherapy and neoadjuvant chemotherapy in cStage III at subanalysis. Methods: Consecutive patients histologically diagnosed with ESCC and planned to undergo radical surgery followed by adjuvant chemotherapy (ADJ) from September 2002 to April 2007 and radical surgery following NAC from May 2007 to December 2011 as initial treatment were eligible for this retrospective study. To select patients who could tolerate transthoracic esophagectomy, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. As adjuvant and neoadjuvant chemotherapy, cisplatin and 5-fluorouracil were administered every 3 weeks for 2 cycles (FP). Patient characteristics, 3-year overall survival (3yOS) and non complete resection rate were investigated. We analyzed in intent-to-treat analysis. Results: Ninety patients were included in ADJ group, 98 included in NAC group. No significant differences were observed in clinicopathological factors between ADJ group (cStage IB/II/III/IV=6/22/57/5) and NAC group (cStage IB/II/III/IV=10/28/52/8). In intention-to-treat analysis, there was no significant difference in 3yOS rate by ADJ group and NAC group (ADJ group, 67.2%; NAC group, 66.0%; p = 0.301). However, non complete resection rate was significantly higher for NAC group than for ADJ group {ADJ group, 16.7% (3/90); NAC group, 3.4% (14/98); p = 0.009}. In cStage III, non complete resection rate of ADJ group was 3.5% (2/57) and NAC group was 25% (13/52). In the patients with cStage III, NAC group had a tendency for 3yOS rate to be low rather than ADJ group (ADJ group, 66.3%; NAC group, 51.1%; p = 0.09). Conclusions: In cStage III advanced ESCC, FP as NAC may be insufficient and development of the more powerful NAC is desired.