Neoadjuvant DCF in resectable esophageal cancer: Single-center experience.

Abstract

124 Background: Despite improvement in surgical techniques and peri-operative care, the 5 yr OS in esophageal cancer is 10%. RCTs comparing NACT to surgery alone have demonstrated a significant increase in median survival from 13 months to 17 months. We aimed at studying impact of DCF NACT. Methods: Retrospective analysis of prospective database of patients with locally advanced esophageal cancer. All patients had ECOG performance status of 0 to 1, with no uncontrolled comorbidities. Chemotherapy consisted of 3 cycles of standard DCF (Docetaxel 75 mg/m2 on day1, Cisplatin 75 mg/m2 on day 1 and 5 fluorouracil 750mg/m2 as a continuous intravenous infusion for 5 days) with growth factors and prophylactic antibiotics were administered. Following chemotherapy, a restaging scan was performed. If disease was deemed resectable, surgery was performed. Patients were followed up after surgery and then 3-monthly. Toxicity was graded according to CTCAE v.4.03, response was calculated as per RECIST 1.1 and statistics were by simple percentages. OS and PFS calculated by Kaplan–Meier method. Results: Between February 2010 and April 2012, there were 22 patients who received neoadjuvant DCF chemotherapy. Male to female ratio 1.2. Median age 44.5 years (range: 32- 63 yrs). 20 patients had squamous histology and 2 had adenocarcinoma. Middle one third of esophagus was the primary site in 54.5%. Response rate: CR-32%, PR-55%, SD-9% and PD-4.5%. 16 (73%) patients underwent R0 resections, 1-R1 resection, 3-R2 resection, 1 was deemed unresectable preoperatively and treated with chemo-radiotherapy and 1 had CR but surgery was postponed due to hyperthyroidism. 7 patients (31.8%) had pathologic complete remission. Toxicities grade (3/ 4) included neutropenia (77.3%), febrile neutropenia (86.4%), diarrhea (45.5%), hyponatremia (45.5%), fatigue (18.2%), and mucositis (13.5%). Dose reduction due to toxicities was done in 50% patients. At a median follow up period of 13 months (range 4-31 months), the PFS is 81.8% and OS is 90.9%. Conclusions: Response rate to DCF is 87%, with a pathologic CR rate of 32%. The complete responders appear to have a durable benefit; all remain disease free at the last date of follow up. Our initial data looks promising but follow up period is short.