Evaluation of Survival Rate and Non-Fetal Outcomes in Patients with Esophageal Cancer Under Treatment with Neoadjuvant Chemoradiotherapy Plus Additional Platinium-Based Chemotherapy from 2010 to 2016

Abstract

Background: Esophageal cancer is an invasive lethal disease with a 10-year survival rate since diagnosis. About 45% of the tumor is completely removed by surgery, which has 5% mortality and 20% survival rate. In the locoregional stage, the use of neoadjuvant chemoradiotherapy and then surgery reduces recurrence and increases survival. Objectives: This study was performed to investigate the effect of neoadjuvant chemoradiotherapy and the subsequent chemotherapy with platinum-based regimen on survival, recurrence, and response to treatment. Methods: Planning a descriptive retrospective follow-up study, during 2010 to 2016, 44 patients with esophageal cancer, who received chemotherapy with 5-Fluorouracil + Oxaliplatin + Docetaxel before and after radiotherapy (45 - 50 Gray) accompanying by oral Capecitabin, were followed up. Five operable patients underwent surgery. Response to treatment and recurrence were evaluated by periodic endoscopic biopsy and imaging. To calculate the response rate to treatment, survival, and recurrence, the data were extracted and analyzed, using SPSS version 18. The categorized variables were compared, using Pearson’s test. The survival curves were drawn, using the Kaplan Meier method and compared with the log-rank test. Results: Among 44 patients with an average age of 61.5 ± 11.5 years, 88.6% had squamous cell carcinoma (SCC) and 11.4% had adenocarcinoma; surgery was performed for 5 patients, one of whom had severe complication leading to death and 54.5% had complete response as well as more survival rate. The patients suffering from SCC and middle segment tumors had more response rate. Also, recurrence was seen in 16 patients (36.4%), of whom 9.1% had local recurrence and 27.3% had metastatic recurrence. The mean survival rate was 38.87 months and 1-, 3-, and 5-year survival rate was %81.6, %47.6, and 39.6%, respectively. It was significantly more in middle esophageal segment and also tumors with complete response to treatment. Conclusions: Regarding the results, this treatment approach increases overall and disease-free survival, and response to treatment and reduces locoregional recurrence even if no surgery is performed. This treatment is recommended as a definitive treatment for esophageal cancer without metastasis.