J Cancer 2017; 8(17):3441-3447. doi:10.7150/jca.21131
Comparative Outcomes of Induction Chemotherapy Followed By Definitive Chemoradiotherapy versus Chemoradiotherapy Alone In Esophageal Squamous Cell Carcinoma
1. State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute;Collaborative Innovation Center for Cancer Medicine, Guangzhou, China;
2. Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China;
3. Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China.
Note: The first two authors contributed equally to this work.
Luo LL, Xi M, Yang YD, Li QQ, Zhao L, Zhang P, Liu SL, Liu MZ. Comparative Outcomes of Induction Chemotherapy Followed By Definitive Chemoradiotherapy versus Chemoradiotherapy Alone In Esophageal Squamous Cell Carcinoma. J Cancer 2017; 8(17):3441-3447. doi:10.7150/jca.21131. Available from http://www.jcancer.org/v08p3441.htm
Purpose: To compare the clinical outcomes of induction chemotherapy (IC) followed by chemoradiotherapy (CRT) versus chemoradiotherapy alone in patients with locally advanced esophageal squamous cell carcinoma (ESCC).
Patients and methods: Between 2002 and 2015, 267 ESCC patients who received definitive CRT with docetaxel and cisplatin were enrolled in this study. Through a matched case-control study, 85 patients receiving IC before CRT were matched 1:1 to patients who received CRT alone, according to age, gender, performance status, tumor location, tumor length, and pretreatment TNM stage.
Results: The median overall survival (OS) in the IC group was significantly better than that in the CRT group (26.0 vs. 22.0 months), with 3-year OS rates of 30.6% vs. 25.9%, respectively (P = 0.028). However, IC plus CRT was associated with a significantly higher rate of grade 3-4 leukopenia than CRT alone (P = 0.048). The overall clinical response rate was 50.6% after IC in the IC group. The IC responder group showed significantly more favorable OS (P=0.002) and progression-free survival (P=0.001) compared with the IC non-responder group and the CRT group. Multivariate analysis revealed that age ≥ 60 (P = 0.003) and the addition of IC (P=0.016) were independent prognostic factors that affected survival positively.
Conclusions: The addition of IC before CRT yielded satisfactory clinical outcomes and manageable toxicities. The combination of IC with CRT might be a promising treatment strategy to further improve systemic control and survival in ESCC. Prospective randomized trials are required to confirm the role of IC.
Keywords: Esophageal squamous cell carcinoma, induction chemotherapy, definitive chemoradiotherapy, survival, toxicity.