Abstract
Multimodal treatment combining surgery with chemotherapy and/or radiotherapy is necessary to improve the chances of survival in patients with locally advanced thoracic esophageal cancer. Based on the results of the Japan Clinical Oncology Group 9907 (JCOG9907) trial, neoadjuvant chemotherapy, two courses of cisplatin and 5‐fluorouracil (5‐FU), followed by esophagectomy with D2 lymphadenectomy is the recommended treatment in Japan. Alternatively, neoadjuvant chemoradiotherapy (NACRT) typified by carboplatin and paclitaxel plus concurrent radiotherapy with 41.4 Gy (Chemoradiotherapy for Esophageal Cancer followed by Surgery Study [CROSS]) has shown promising outcomes in some Western countries. Currently, several clinical trials are being conducted within and outside of Japan to confirm the best neoadjuvant treatment regimen. For instance, a three‐arm phase III randomized controlled trial (JCOG1109) is ongoing in Japan. The three arms comprise a doublet regimen (two courses of cisplatin 80 mg/m2 day 1 and 5‐FU 800 mg/m2 days 1‐5; repeated every 3 weeks) versus a triplet regimen (three courses of docetaxel, 70 mg/m2 day 1; cisplatin 70 mg/m2 day 1; and 5‐FU 750 mg/m2 days 1‐5; repeated every 3 weeks) versus a chemoradiotherapy (CRT) regimen (radiotherapy of 41.4 Gy/23 fractions with two courses of cisplatin 75 mg/m2 day 1 and 5‐FU 1000 mg/m2 days 1‐4; repeated every 4 weeks). Development of a multimodal strategy for neoadjuvant therapy is expected to receive the continuous focus of research in the hope of achieving better outcomes from treatment of patients with advanced thoracic esophageal cancer.
Highlights
Thoracic esophageal cancer is an aggressive malignant tumor with poor prognosis, in the advanced stage
In Japan, esophageal cancer is a major cause of mortality that accounts for the seventh largest number of cancer-associated mortality cases, totaling 11 500 deaths in 2017.2 As for histopathological type, squamous cell carcinoma (SCC)
AC, adenocarcinoma; CR, complete response; CROSS, Chemoradiotherapy for Esophageal Cancer followed by Surgery Study; CRT, chemoradiotherapy; computed tomography (CT), chemotherapy; DFS, disease-free survival; ECF, epirubicin + cisplatin + 5-fluorouracil; ECX, epirubicin + cisplatin + capecitabine; EGJ, esophagogastric junction; FLOT, docetaxel + oxaliplatin + leucovorin + fluorouracil; MAGIC, Medical Research Council Adjuvant Gastric Infusional Chemotherapy; NA, not available; NAC, neoadjuvant chemotherapy; NS, not statistically significant at level of 0.05; OS, overall survival; RT, radiotherapy; SCC, squamous cell carcinoma
Summary
Thoracic esophageal cancer is an aggressive malignant tumor with poor prognosis, in the advanced stage. In 2018, esophageal cancer ranked seventh as a common malignancy worldwide, accounting for. 572 000 new cases, as well as the sixth most frequent cause of cancer death, accounting for 509 000 deaths.[1] In Japan, esophageal cancer is a major cause of mortality that accounts for the seventh largest number of cancer-associated mortality cases, totaling 11 500 deaths in 2017.2 As for histopathological type, squamous cell carcinoma (SCC)
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