Abstract
Neoadjuvant therapy improves long-term locoregional control and overall survival after surgical resection for esophageal cancer, and neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT) are commonly used in clinical practice. Nimotuzumab is a humanized monoclonal antibody against epidermal growth factor receptor (EGFR), the efficacy of nimotuzumab added to nCRT for esophageal cancer is uncertain. We conducted this retrospective study in which combining neoadjuvant treatment of nimotuzumab with chemoradiotherapy (Nimo-nCRT) is compared with nCRT and nCT for patients with potentially resectable locally advanced esophageal squamous cell carcinoma. One hundred ninety-five patients received neoadjuvant therapy and 172 (88.2%) underwent esophagectomy. Surgical resection was performed in 94.4% after Nimo-nCRT, versus 92.5% after nCRT and 83.5% after nCT (P = 0.026). The R0 resection rate was 100% after Nimo-nCRT, 95.9% after nCRT and 92.6% after nCT (P = 0.030). Pathological complete response (pCR) was achieved in 41.2% after Nimo-nCRT, versus 32.4% after nCRT and 14.8% after nCT (P = 0.0001). Lymph-node metastases were observed in 29.4% in the Nimo-nCRT group, versus 21.6% in the nCRT group and 35.8% in the nCT group (P = 0.093). More patients in the Nimo-nCRT and nCRT group developed grade 3 esophagitis compared to those in the nCT group, P = 0.008. There was no difference in surgical complications between the treatment groups. nCRT results in improved R0 resection, higher pCR rate, and a lower frequency of lymph node metastases compared to nCT, adding nimotuzumab to nCRT is safe and appears to facilitate complete resection and increase the pCR rate.
Highlights
Esophageal cancer is an aggressively human malignancy, surgical resection by itself provides a high degree of locoregional relapse and distant metastasis for locally advanced disease [1]
Neoadjuvant therapy improves long-term locoregional control and overall survival after surgical resection for esophageal cancer, and neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy are commonly used in clinical practice
We conducted this retrospective study in which combining neoadjuvant treatment of nimotuzumab with chemoradiotherapy (NimonCRT) is compared with neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for patients with potentially resectable locally advanced esophageal squamous cell carcinoma
Summary
Esophageal cancer is an aggressively human malignancy, surgical resection by itself provides a high degree of locoregional relapse and distant metastasis for locally advanced disease [1]. Neoadjuvant therapy improves long-term locoregional control and overall survival for esophageal cancer patients undergoing esophagectomy, and two main neoadjuvant approaches are commonly used in clinical practice. R0 resection, pathological complete response (pCR) and downstaging have been regarded as www.oncotarget.com strong and relevant predictors of increased survival in esophageal cancer patients who were undergoing neoadjuvant therapy [1, 4,5,6], nCRT shows the advantages of effective local therapy in combination with systemic treatment, and the benefits of the radiosensitising effect of chemotherapy compared with nCT. The recently published NeoRES trial in a mixed cohort of 181 patients with esophageal squamous cell carcinoma and adenocarcinoma of the distal esophagus, manifested that nCRT increases the pCR and R0 resection rates and decreases the proportion of patients with metastases in regional lymph nodes compared to nCT, though dose not significantly improve overall survival in squamous cell carcinoma patients [7]
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