Adjuvant Chemotherapy and Dose Escalation in Definitive Concurrent Chemoradiotherapy for Esophageal Squamous Cell Carcinoma

Abstract

Background/Aim: To validate the effect of treatment intensification on survival in esophageal squamous cell carcinoma (ESCC) patients undergoing definitive concurrent chemoradiotherapy (dCCRT). Patients and Methods: We reviewed the medical records of 73 ESCC patients who underwent dCCRT between 2006 and 2017 in 3 institutions. Results: The median follow-up time was 13.3 months. The median overall survival (OS) and locoregional recurrence-free survival (LRFS) were 13.3 and 11.2 months, respectively. The median radiotherapy dose was 55.8 Gy, and the median biologically effective dose (BED) was 65.8 Gy. Chemotherapy was given in all patients during dCCRT, and adjuvant chemotherapy was administered in 56 patients (76.7%). Adjuvant chemotherapy improved 24.2% vs. 11.8%, p=0.004). Higher BED ≥70 Gy improved 41.7% vs. 23.6%, p=0.035). Conclusion: The addition of chemotherapy after dCCRT improves OS. A higher radiotherapy dose improved LRFS, but not OS. Adjuvant chemotherapy should be considered after dCCRT for better outcomes.

Long-Term Survival in Nonsurgical Esophageal Cancer Patients Who Received Consolidation Chemotherapy Compared With Patients Who Received Concurrent Chemoradiotherapy Alone: A Systematic Review and Meta-Analysis

“…shows that CCRT with docetaxel plus cisplatin had comparable OS and PFS to CCRT with the 5-Fluorouracil plus cisplatin regimen. Each of these 3 studies ( 10 , 18 , 20 ) shows that CCT can prolong patient survival time without increasing treatment-related toxicity, and the results of the data aggregation in our meta-analysis are consistent with their results.…”

“…In the included studies, only 2 articles reported the survival outcome of locoregional failure-free survival (LFFS). Koh, H. K ( 18 ). report that CCT prolonged LFFS, and Chen, M ( 11 ).…”

“…We further analyzed the data eligible in our articles and found that the clinical features of 7 of those articles are similar in the CCT and the CCRT-alone groups. The clinical features in 4 articles were not detailed ( 9 , 18 , 23 , 24 ). The numbers of patients who did not accept CCT after CCRT reported by Koh, H. K. et al ( 18 ).…”

“…The clinical features in 4 articles were not detailed ( 9 , 18 , 23 , 24 ). The numbers of patients who did not accept CCT after CCRT reported by Koh, H. K. et al ( 18 ). and Dae-Eun Kim, et al ( 9 ) are 17 and 16, respectively.…”

“…After full text screening, 57 studies were excluded for reasons such as lack of relevant data or data duplication. Finally, 11 case-control studies were included in this metaanalysis (8)(9)(10)(11)(18)(19)(20)(21)(22)(23)(24).…”