Original article
General thoracic
Results of Neoadjuvant Chemoradiotherapy With Docetaxel and 5-Fluorouracil Followed by Esophagectomy to Treat Locally Advanced Esophageal Cancer

https://doi.org/10.1016/j.athoracsur.2015.02.042Get rights and content

Background

Esophageal cancer is most frequently treated with platinum-based chemoradiotherapy (CRT). We previously described a phase I study of definitive CRT with docetaxel (DOC) and 5-fluorouracil (5FU) in patients with advanced esophageal cancer. This regimen had low toxicity and was effective without platinating agents. The present study aims to determine the antitumor effects of neoadjuvant CRT with DOC and 5FU and surgical outcomes.

Methods

We reviewed data from 38 patients with locally advanced cancer of the esophagus or esophagogastric junction who underwent trimodality therapy comprising neoadjuvant CRT with DOC and 5FU followed by esophagectomy between 2003 and 2008.

Results

Esophagitis was the most common toxicity associated with neoadjuvant CRT (grade 3; 26.3%), and hematologic toxicity was mild. Transthoracic esophagectomy and pharyngolaryngoesophagectomy proceeded in 36 (94.7%) and 2 (5.3%) patients, respectively, and 35 (92.1%) underwent R0 resection. Five (13.2%) patients had complete pathologic responses (pCR) of the primary tumor, and 23 (60.5%) had pathologic reductions of over two-thirds of the primary tumor. The T or N status was also down-staged in 26 (68.4%) patients. Overall postoperative morbidity developed in 21 (55.3%) patients, and mortality due to postoperative morbidity was zero. The 5-year recurrence-free and overall survival rates were 39.5% and 44.7%, respectively.

Conclusions

The rates of neoadjuvant CRT toxicity and postoperative complications were acceptable, and the complete resection rate and survival data were favorable. This regimen is promising as neoadjuvant CRT for esophageal cancer and very useful as an alternative regimen for treating patients with esophageal cancer who cannot tolerate cisplatin.

Section snippets

Patient Characteristics

We reviewed data from 38 patients (male, n = 34; female, n = 4; mean age, 61.3 ± 9.2 years; range, 42 to 78 years) who received neoadjuvant CRT with DOC and 5FU followed by esophagectomy between September 2003 and January 2008 (Table 1). This was the preferred neoadjuvant CRT regimen for treating resectable advanced esophageal cancer in our institute at the time. The present retrospective review of a prospective database was approved by the Institutional Review Board at Hiroshima University.

Clinical Effect and Toxicity of Neoadjuvant Chemoradiotherapy

All patients completed the neoadjuvant CRT regimen. The clinical outcomes of neoadjuvant CRT comprised a complete response (CR) in 2 (5.3%) patients, a partial response in 29 (76.3%), stable disease in 6 (15.8%), and progressive disease in 1 (2.6%). Therefore, the overall clinical response rate was 81.6%. One patient with progressive disease developed lymph node metastasis outside the irradiation field after neoadjuvant CRT.

Table 2 shows the toxicity of neoadjuvant CRT. Hematologic toxicity was

Comment

We previously reported a phase I study of setting the doses of DOC and 5FU for definitive CRT to treat advanced esophageal cancer [13], and plan to publish the results of a phase II study of this definitive CRT. Moreover, we found high antitumor activity in a phase II study of combination chemotherapy with DOC and the oral fluorouracil antitumor drug S-1 for treating advanced or recurrent gastric cancer [23]. We applied neoadjuvant CRT to patients with esophageal cancer based on these

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