Pathologic downstaging with taxane-based neoadjuvant chemotherapy correlates with increased survival in patients with locally advanced esophageal cancer

Abstract

4039 Background: We previously reported the effect of neoadjuvant chemoradiotherapy on pathologic stage and survival in patients with locally advanced esophageal cancer treated with concurrent cisplatin, 5-FU and radiotherapy (RT) followed by surgery. This study aimed to evaluate these outcomes in patients treated with taxane-based neoadjuvant chemoradiotherapy. Methods: Patients (n=67) received taxane-based induction chemoradiotherapy followed by esophagectomy. Survival calculated from time of surgery was stratified by pathologic stage and controlled for clinical factors. Results: Characteristics included: age (range 40 to 76 years); gender (64 male; 3 female); and histology (59 adeno; 8 squamous cell). Pre-treatment stages were: IIA (n=2); IIB (n=8); III (n=49) and IVa (n=8). Treatment led to downstaging in 54 patients, and 19 patients achieved a pathologic complete response. Post-treatment (pathologic) stages were: 0 (n=19); I (n=6); IIA (n=26); IIB (n=7); III (n=6); IV (n=3). The number of interval stage reductions (pre versus post treatment) was: none (n=13); 1 (n=6); 2 (n=21); 3 (n=9); 4 (n=17); and 5 (n=1). Median survival is 47.5 months with minimum follow up of 5 months for surviving patients. Number of stage reductions did not correlate with survival (p = 0.83 by chi2), and 6/13 patients with no downstaging are alive. Median survivals for each pathologic stage were: 0 (not reached); I (31 months); IIA (35 months); IIB (17 months); III (11 months); and IV (4 months) [p < 0.01 by logrank test]. In a Cox multivariate model adjusted for age, gender and histology, higher pathologic stage correlated with worse survival (HR 1.44; 95% CI 1.12–1.86). Conclusions: Taxane-based neoadjuvant chemoradiotherapy for resectable esophageal cancer leads to pathologic downstaging in most patients, and lower pathologic stage correlates with better survival. These results are similar to those achieved with cisplatin and 5-FU. No significant financial relationships to disclose.