Neoadjuvant chemotherapy using concurrent docetaxel/CDDP/5-FU (DCF) in esophageal squamous cell carcinoma and its excellent short-term prognosis.

Abstract

e15122 Background: Neoadjuvant chemotherapy (NAC) using 5-FU/CDDP (FP) followed by surgery is a standard treatment for esophageal squamous cell carcinoma (ESCC). However, this therapy often encountered progression during the early course of treatment. We are developing the novel NAC using Docetaxel/CDDP/5-FU (DCF). Methods: Thirty eight patients who underwent DCF NAC in cStage II/III ESCC was compared with the 41 counterparts treated by FP NAC. Docetaxel and CDDP were both given to 70-75 mg/ m2 with concurrent 5-FU at 750 mg/m2in 3 cycles. Median follow-up term of DCF NAC reached 18 months. Results: In DCF NAC, grade 3 adverse effects (AEs) were recognized in 97% (37/38), however non-hematological AEs exhibited 8% in stomatitis and 5% in anorexia, and completion rate of the DCF NAC was 86 %. In terms of PR+CR rate, DCF NAC was remarkably more excellent (33/38: 86.8%) than FP NAC (24/41: 58.5%)(P=0.0050). In DCF NAC therapy, 30 patients underwent surgery including 24 R0 esophagectomy, whereas another 8 patients selected definitive chemoradiation therapy. We experienced 3 patients with a pathologic complete response (ypCR)(10%) in DCF NAC. The 1st univariate prognostic analysis for progression free survival (PFS) among all the cases with NAC revealed that significant factors were R0 resection (P<0.0001), cT factor (P=0.0098), and NAC modality (P=0.1), and multivariate proportional hazard model identified these 3 factors as independent prognostic factors (IPFs). We then performed the 2nd stage multivariate prognostic analysis limited to R0 cases including pathologic factors for PFS. The univariate negative prognostic factors were FP NAC (P=0.0064), ypT3 (P=0.032), ypN3 (P=0.0017), ypv2/3 (P=0.0072), as well as cT3 (P=0.033), and multivariate analysis identified only NAC modality. DCF NAC was significantly associated with less frequency of ypT3 (P=0.019) and ypv2/3(P=0.013). Conclusions: Novel DCF NAC for ESCC demonstrated high response rates, and is promising for excellent survival in R0 cases, with acceptable feasibility. It improved the patient survival through downstage of the significant prognostic factors.