Concurrent cisplatin and 5-fluorouracil versus concurrent cisplatin and docetaxel with radiotherapy for esophageal squamous cell carcinoma: a propensity score-matched analysis.

Peng Zhang,Qing Liu,Hui Liu,Li-Ling Luo,Shi-Liang Liu,Yong-Hong Hu,Meng-Zhong Liu,Qiao-Qiao Li,Mian Xi,Lei Zhao,Xiaobo Guo

doi:10.18632/oncotarget.9301

Abstract

The optimal concurrent chemotherapy regimen with radiotherapy for esophageal cancer is unknown. Here, we compared the survival outcomes and toxicity of definitive chemoradiotherapy with either cisplatin/5-fluorouracil (PF) or docetaxel/cisplatin (DP) in patients with unresectable esophageal squamous cell carcinoma (ESCC). In this study, we identified 317 patients with ESCC who received PF or DP concurrently with definitive radiotherapy. PF group patients received two cycles of cisplatin (60 mg/m2) and 5-fluorouracil (300 mg/m2) at 4-week intervals during radiotherapy. DP group patients received a concurrent three-weekly schedule of docetaxel (60 mg/m2) and cisplatin (80 mg/m2) or cisplatin (25 mg/m2) and docetaxel (25 mg/m2) weekly. The overall survival (OS) and progression-free survival (PFS) were compared using propensity score (−adjusted, −weighted, −stratified, and −matched) analyses. A sensitivity analysis was performed to examine the impact of unmeasured confounders. Inverse probability of treatment weighting for propensity score demonstrated an improvement in OS and PFS with DP group in comparison with PF group (hazard ratio, 0.700; 95% CI, 0.577-0.851) and similar results were achieved with propensity score matching and stratification. Grade 3-4 esophagitis was more common (16/102 vs. 4/102) and grade 3-4 thrombopenia and skin toxicity were less common (3/102 vs. 10/102; 7/102 vs. 19/102; respectively) in the PF group than the DP group. In conclusion, concurrent chemoradiotherapy with the DP regimen resulted in better OS and PFS compared to concurrent PF regimen with tolerable toxicities in ESCC patients. Prospective randomized trials are required to confirm the efficacy of the DP regimen.

Highlights

Esophageal cancer represents a considerable health problem globally and has a 5-year survival rate of approximately 17% [1]
To gain insight into the relative efficacy and toxicities of the cisplatin and fluorouracil (PF) and DF regimens, we retrospectively reviewed patients diagnosed with esophageal squamous cell carcinoma (ESCC) treated at our institution with definitive radiotherapy combined with either concurrent PF or DP
In multiple logistic regression analysis, treatment at an earlier era and a lower histologic grade were associated with the receipt of PF (Table 2)

Summary

Introduction

Esophageal cancer represents a considerable health problem globally and has a 5-year survival rate of approximately 17% [1]. Chemoradiotherapy is the standard treatment for unresectable esophageal cancer. Randomized controlled trials have established the superiority of concurrent chemoradiotherapy over radiotherapy alone in localized esophageal cancer [2, 3]. The most commonly-applied regimen for www.impactjournals.com/oncotarget radiosensitization in esophageal cancer is the doublet combination of cisplatin and 5-fluorouracil (PF). The outcomes of this regimen remain unsatisfactory in terms of local control, toxicity and overall survival benefit [4, 5, 6]. More effective regimens need to be investigated to improve the prognosis of patients with locally advanced esophageal cancer

Methods

Results

Conclusion