Stage Ⅱ clinical study of preoperative concurrent chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma
Wu Xiaoyuan*, Xing Wenqun, Liu Jinsong, Wang Wen, He Chunyu, Chen Yongshun, Yang Yuanyuan, Hao Daxuan, Wang Jianhua
*Department of Radiation Oncology, Zhengzhou University Affiliated Cancer Hospital, Henan Cancer Hospital, Zhengzhou 450008, China Corresponding anthor:Wang Jianhua, Email:huanjianye@sina.cn
Abstract：Objective To evaluate the long-term overall survival (OS) and the incidence of postoperative complications in locally advanced esophageal squamous cell carcinoma (ESCC) patients treated with preoperative concurrent chemoradiotherapy followed by surgery. Methods From 2007 to 2013, a total of 46 ESCC patients were enrolled. The chemoradiotherapy regimen consisted of one cycle of cisplatin (75 mg/m2, intravenous infusion on days 1-3) and 5-fluorouracil (500 mg/m2, intravenous infusion on days 1-5);three-dimensional conformal radiotherapy was also performed with a total dose of 40 Gy delivered at 2.0 Gy/fraction, 5 fractions per week. Esophagectomy was performed 4 weeks after the chemoradiotherapy. Results All the 46 patients completed the preoperative chemoradiotherapy, and 44 patients underwent surgery. Preoperative chemoradiotherapy led to a clinical response rate of 94% and had mild toxicities. The rate of radical resection was 96%, and the pathologic complete response (pCR) rate was 30%. The incidence rates of postoperative pulmonary infection, anastomotic leak, hoarseness, and neck wound infection and perioperative mortality were 14%, 7%, 5%, 2%, and 2%, respectively. The 1-, 3-, and 5-year sample sizes were 38,29 and 27, respectively, and the 1-, 3-, and 5-year OS rates for all patients were 84%, 54%, and 45%, respectively. The 1-, 3-, and 5-year OS rates for the pCR group were 89%, 49%, and 49%, respectively, versus 82%, 60%, and 44% for the non-pCR group (P=0.681). The 1-, 3-, and 5-year OS rates for 37 patients with downstaged disease after chemoradiotherapy were 94%, 68%, and57%, respectively, versus 43%, 0, and 0 for non-downstaged patients (P=0.000). Conclusions Preoperative concurrent chemoradiotherapy followed by surgery is effective for locally advanced ESCC and does not increase postoperative complications. Patients who are downstaged following chemoradiotherapy have significantly improved long-term OS, but it needs to be confirmed by a larger sample.
Wu Xiaoyuan,Xing Wenqun,Liu Jinsong et al. Stage Ⅱ clinical study of preoperative concurrent chemoradiotherapy followed by surgery for locally advanced esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2015, 24(1): 25-28.
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2015, Vol. 24 
