Effectiveness of induction chemotherapy consisting of docetaxel, cisplatin, and S-1 (DCS) followed by esophagectomy for cT4 esophageal cancer

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Introduction: The prognosis of cT4 esophageal cancer is dismal unless the tumor is completely removed by esophagectomy after induction treatment successfully reducing the tumor volume. However, esophagectomy for cT4 esophageal cancer after induction treatment is associated with high morbidity and mortality rates and recommended induction treatment remains unclear. The aim of the study is to evaluate the feasibility and efficacy of 3-course chemotherapy consisting of docetaxel, cisplatin, and S-1 (DCS) followed by esophagectomy in comparison with 2-course chemotherapy consisting of 5-FU, doxorubicin, and nedaplatin (FAN) for cT4 esophageal cancer in a prospective cohort study. Methods: Since 2002, we have performed a prospective cohort study of induction treatment in patients with cT4 esophageal cancer. FAN chemotherapy, 40-66 Gy chemoradiotherapy, and DCS chemotherapy was performed in patients with cT4 esophageal cancer during the period of 2002-2006, 2006-2013, and 2013-2016, respectively. The short- and long-term results of DCS group (n = 18) were compared with FAN group (n = 17). In DCS group’s patients, cStage III and IV diseases were found in 1 and 17 respectively, whereas the respective number was 3 and 14 in the FAN group’s patients. Results: The completion rate of the planned therapy was 89% and 65% in the DCS and FAN group, respectively (p = 0.121). The response rate for primary tumor (83%) of DCS group was significantly higher than that (35%) of FAN group (p = 0.006). However, the occurrence rate of the toxicity grade 3 or higher was not significantly different between two groups: 61% and 47% in the DCS and FAN group, respectively (p = 0.505). There were no treatment-related deaths during the chemotherapy in two groups. The esophagectomy rate was 67% of DCS group and 59% of FAN group, respectively (p = 0.733). R0 resection rate was 61% of DCS group and 47% of FAN group, respectively (p = 0.505). There were not significantly different between two groups but DCS group showed high Esophagectomy and R0 resection rates in comparison with FAN group. The surgery-related morbidity rate was 75% and 50% in DCS and FAN groups, respectively (p = 0.378). There were not significantly different between the 2 groups. The surgery-related mortality was occurred in two patients of FAN group, but there were not in DCS group. The 5-years overall survival rates for all patients, the 45% of DCS group was significantly better than 12% of FAN group (p = 0.029). Conclusion: The induction DCS therapy is safe and feasible, and has strong power to reduce tumor volume (response rate: 83%) even in cases of T4 esophageal tumor. Esophagectomy and R0 resection rates after the DCS therapy were better than those after the FAN therapy. Furthermore, the 5-years overall survival rates for all patients in DCS group significantly better than that in FAN group. Therefore, the DCS therapy may be promising as the induction treatment for cT4 esophageal cancer.