Abstract
Definitive chemoradiotherapy (dCRT) is the standard treatment for unresectable esophageal cancer. Induction chemotherapy has been actively investigated for borderline-resectable and unresectable disease, but the superiority over dCRT has yet to be confirmed. The purpose of this study was to evaluate the outcome of dCRT with special interest in borderline-resectable disease. Patients with esophageal cancer treated with dCRT between January 2004 and November 2016 were included in this retrospective analysis. Chemotherapy consisted of two cycles of cisplatin (70–75 mg/m2) on day 1 and 5-fluorouracil (700–1000 mg/m2 per day) on days 1–4 or low-dose cisplatin (10 mg/m2 per day) and 5-fluorouracil (175 mg/m2 per day) for 20 days. Radiotherapy was given with a daily fraction of 1.8–2 Gy to a total dose of 50–70 Gy. A total of 104 patients were included: 34 were resectable, 35 were borderline-resectable and 35 were unresectable. Complete response was achieved in 44 patients (42%). Eighteen patients (17%) suffered Grade 2 or greater cardiopulmonary toxicity and seven patients (7%) suffered Grade 3 cardiopulmonary toxicity. At the time of this analysis, 59 patients were dead and 45 were censored. The 3-year overall survival proportions for resectable, borderline-resectable and unresectable patients were 64%, 46% and 21%, respectively. The overall survival for borderline-resectable patients with complete response and noncomplete response was significantly different (P < 0.001), with 3-year survival of 70% and 8%, respectively. The overall survival for complete response patients with borderline-resectable disease was encouraging. Further investigation to find a subgroup fit for esophagus-preserving treatment is warranted.
Highlights
Definitive chemoradiotherapy is the standard treatment for nonmetastatic squamous cell carcinoma of the esophagus when the disease is unresectable or patients prefer nonsurgical treatment [1– 5]
Phase III studies to evaluate the non-inferiority of Definitive chemoradiotherapy (dCRT) compared with chemoradiotherapy (CRT) followed by surgery are ongoing for resectable disease
The treatment outcome for locally advanced disease is still dismal, and induction chemotherapy with or without concurrent radiotherapy has been investigated for unresectable disease expecting conversion surgery [6–10]; the superiority of this approach over dCRT is yet to be confirmed
Summary
Definitive chemoradiotherapy (dCRT) is the standard treatment for nonmetastatic squamous cell carcinoma of the esophagus when the disease is unresectable or patients prefer nonsurgical treatment [1– 5]. Phase III studies to evaluate the non-inferiority of dCRT compared with chemoradiotherapy (CRT) followed by surgery are ongoing for resectable disease. The concept of borderline-resectable disease was proposed, with a treatment strategy that is different from resectable and unresectable disease being sought. The number of reports focusing on borderline-resectable disease is limited, and more data are needed to establish the standard treatment, including an esophagus-preserving strategy. The purpose of this study was to evaluate the outcome of dCRT, with special interest in borderline-resectable disease, and to generate a hypothesis that overall survival after dCRT is not inferior to that after surgery following induction therapy in patients with borderline-resectable disease who responded well to CRT
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