Neoadjuvant chemotherapy (NACT) with DCF regimen in stage III, squamous cell cancer: Esophagus followed by oesophagectomy—Indian experience.

Abstract

e14710 Background: Despite improved surgical techniques and peri-operative care in cancer of the esophagus, the 5 yr OS is 10%. Additional therapy could improve prognosis. At least 10 RCTs comparing NACT to surgery alone have demonstrated a significant increase in median survival of 17 months in the former, compared to 13 months in the latter. We aimed at studying impact of NACT in Indian patients and its impact on surgery and outcome. Methods: The study – Prospective non-randomised study. Between 2007-12, 20 patients were included to analyze the benefit of NACT with DCF (docetaxel 75mg/m2 day 1, cisplatin 75mg/m2 day 1, 5-FU 750mg/m2 per day 1-4) regimen, in stage III Ca. Esophagus, assessed by EUS and PET-CT scan , pre-chemo and post-chemo, in biopsy proven Squamous cell Carcinoma Oesophagus. Prophylactic growth factors were used in all cycles. Results: Post NACT, Partial response of 58.8%, and a complete pathological response of 17.6% were observed with response rage of 76.4%. NACT x 3 cycles used. 4 pt.s had mucositis, but none had grade 3 toxicity, neutropenia in 4 pt.s and febrile neutropenia in only one pt., vomiting and fatige in 5 pt.s . Surgery post NACT was, very easy and there was no significant morbidity, or surgical complication nor any mortality observed due to NACT. On follow-up, two patients died due to systemic recurrence and progression disease progression. Two patients had regional and one patient had , non-regional lymph node disease recurrence. In remaining 16 patients, till to date there is no recurrences and are disease free. All but 2 patients are alive to date. Conclusions: The response rate to NACT (TPF-Regimen) is 76.4%, with maximum benefit in the complete responders. NACT has no adverse impact on the surgical outcome. Surgery is done with acceptable morbidity and very low mortality. Surgical resection post NACT was easy. Impact of this regimen on DFS and OS, have to be ascertained over time.