Docetaxel, Cisplatin, and 5-FU Triplet Therapy as Conversion Therapy for Locoregionally Advanced Unresectable Esophageal Squamous Cell Carcinoma.

Autor: Chan WL; Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong. winglok@hku.hk., Choi CW; School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Wong IY; Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Tsang TH; LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Lam AT; LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Tse RP; Department of Clinical Oncology, Queen Mary Hospital, Pok Fu Lam, Hong Kong., Chan KK; Department of Surgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong., Wong C; Department of Surgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong., Law BT; Department of Surgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong., Cheung EE; Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Chan SY; Department of Surgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong., Lam KO; Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Kwong D; Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong., Law S; Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2023 Feb; Vol. 30 (2), pp. 861-870. Date of Electronic Publication: 2022 Oct 28.
DOI: 10.1245/s10434-022-12694-8
Abstrakt: Background: The standard treatment for locoregionally advanced unresectable esophageal squamous cell carcinoma was radical chemoradiotherapy. However, the prognosis was modest. Emerging evidence showed the concept of induction chemotherapy with a goal of conversion surgery.
Methods: We reviewed the long-term, clinical outcomes and safety data of induction chemotherapy using docetaxel-cisplatin-5FU (DCF) and subsequent definitive treatment, either surgery or radical chemoradiotherapy (CRT), in locally advanced unresectable esophageal cancer in Queen Mary Hospital, Hong Kong. A total of 47 patients (median age 62 years, male: 41 (87.2%)) with locoregionally advanced unresectable esophageal cancer received induction DCF. The response rate was 65.9% (complete/partial response: n = 31). After induction DCF, 24 patients (41.4%) had radical surgery and 7 (14.9%) had definitive CRT.
Results: The median overall survival (mOS) was significantly longer in patients received subsequent surgery compared with those with definitive CRT (mOS: 40.2 vs. 9.1 months, hazard ratio 3.33, 95% confidence interval 1.22-9.07, p = 0.02) and no definitive treatment (mOS: 40.2 vs. 6.3 months, hazard ratio 8.51, 95% confidence interval 3.7-19.73, p < 0.001). Patients who received surgery, female, and those with supraclavicular lymph node involvement had a better OS. Twenty-one patients (44.7%) developed grade 3/4 adverse events during induction DCF, and two died after chemotherapy because of trachea-esophageal fistula complicated with sepsis. Eleven patients who had surgery had postoperative complications and none had postoperative mortality.
Conclusions: Induction DCF and subsequent conversion surgery offered a chance of cure with long-term survival benefit and manageable toxicities in patients with locoregionally advanced unresectable esophageal cancer.
(© 2022. Society of Surgical Oncology.)
Databáze: MEDLINE
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