Tomoya Yokota1, Ken Kato2, Yasuo Hamamoto3, Yasuhiro Tsubosa4, Hirofumi Ogawa5, Yoshinori Ito6, Hiroki Hara7, Takashi Ura8, Takashi Kojima9, Keisho Chin10, Shuichi Hironaka11, Takayuki Kii12, Yasushi Kojima13, Yasunori Akutsu14, Hisayuki Matsushita15, Kentaro Kawakami16, Keita Mori17, Takashi Makiuchi18, Rie Nagumo18, Yuko Kitagawa19. 1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan. t.yokota@scchr.jp. 2. Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan. 3. Division of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan. 4. Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 5. Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan. 6. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan. 7. Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan. 8. Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan. 9. Department of Gastroenterology, National Cancer Center Hospital East, Chiba, Japan. 10. Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. 11. Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan. 12. Cancer Chemotherapy Center, Osaka Medical College Hospital, Osaka, Japan. 13. Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan. 14. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 15. Department of Surgery, Tochigi Cancer Center, Tochigi, Japan. 16. Department of Medical Oncology, Tochigi Cancer Center, Tochigi, Japan. 17. Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Japan. 18. Clinical Data Management, Clinical Research Data Center, National Cancer Center Hospital, Tokyo, Japan. 19. Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: A multicenter phase 2 trial analysed chemoselection with docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy (ICT) and subsequent conversion surgery (CS) for locally advanced unresectable esophageal cancer. This study presents updated 3-year analyses to further characterize the impact of DCF-ICT followed by CS. METHODS: Esophageal cancer patients with clinical T4 disease, unresectable supraclavicular lymph node metastasis, or both were eligible for this study. The treatment starts with DCF-ICT, followed by CS if the cancer is resectable, or by concurrent chemoradiation if it is not resectable. This updated analysis presents 3-year overall survival (OS), 3-year progression-free survival (PFS), and pattern of relapse. RESULTS: The median follow-up period for the patients surviving without death was 39.3 months. The estimated 1-year OS was 66.7%, and the lower limit of the 80% confidence interval (CI) was 54.6%. The estimated 3-year OS was 46.6% (95% CI 34.2-63.5%). The OS for the patients who underwent R0 resection (n = 19) was significantly longer than for those who did not (3-year OS: 71.4% vs. 30.1%). The estimated 1-year PFS was 50.6%, and the 3-year PFS was 39.6%. The PFS for R0 was significantly longer than for non-R0 (3-year PFS: 61.3% vs 25.0%). Recurrence or progression at the primary site was observed in 31% of the non-R0 group. The rate of distant metastasis did not differ significantly between the non-R0 and R0 groups (21% vs 16%). CONCLUSIONS: Long-term follow-up evaluation confirmed that DCF chemoselection aimed at CS is feasible and promising in terms of survival for patients with locally advanced esophageal cancer.
BACKGROUND: A multicenter phase 2 trial analysed chemoselection with docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy (ICT) and subsequent conversion surgery (CS) for locally advanced unresectable esophageal cancer. This study presents updated 3-year analyses to further characterize the impact of DCF-ICT followed by CS. METHODS:Esophageal cancerpatients with clinical T4 disease, unresectable supraclavicular lymph node metastasis, or both were eligible for this study. The treatment starts with DCF-ICT, followed by CS if the cancer is resectable, or by concurrent chemoradiation if it is not resectable. This updated analysis presents 3-year overall survival (OS), 3-year progression-free survival (PFS), and pattern of relapse. RESULTS: The median follow-up period for the patients surviving without death was 39.3 months. The estimated 1-year OS was 66.7%, and the lower limit of the 80% confidence interval (CI) was 54.6%. The estimated 3-year OS was 46.6% (95% CI 34.2-63.5%). The OS for the patients who underwent R0 resection (n = 19) was significantly longer than for those who did not (3-year OS: 71.4% vs. 30.1%). The estimated 1-year PFS was 50.6%, and the 3-year PFS was 39.6%. The PFS for R0 was significantly longer than for non-R0 (3-year PFS: 61.3% vs 25.0%). Recurrence or progression at the primary site was observed in 31% of the non-R0 group. The rate of distant metastasis did not differ significantly between the non-R0 and R0 groups (21% vs 16%). CONCLUSIONS: Long-term follow-up evaluation confirmed that DCF chemoselection aimed at CS is feasible and promising in terms of survival for patients with locally advanced esophageal cancer.