Early response to neoadjuvant chemotherapy in advanced esophageal cancer evaluated by computed tomography predicts the utility of a second cycle of chemotherapy

Abstract

Abstract. Multi-course neoadjuvant chemotherapy (NACT) followed by surgery is a promising treatment for advanced esophageal cancer. However, non-responders may continue to receive ineffective treatment, since there are no definitive criteria for early discontinuation of NACT. In this study, we analyzed 103 advanced esophageal cancer patients treated with 2 cycles of NACT followed by surgery. Patients with >20% decrease in the size of the primary tumor as evaluated by computed tomography (CT) following the first cycle of chemotherapy, were defined as early responders and the remainder as early non-responders. Clinicopathological factors and prognosis were compared between the 2 groups. The reduction rate of the second cycle and progression-free survival (PFS) of early non-responders were significantly worse than those of early responders (p=0.0001 and 0.0375, respectively). In addition, pathological T stage, pathological assessment of tumor regression and number of metastatic lymph nodes were significantly unfavorable in early non-responders (p=0.023, 0.007 and 0.0041, respectively). Among the clinical factors that were available prior to administration of the second cycle, clinical T3 stage and early non-responder status were the only independent unfavorable factors (p=0.028 and 0.0062, respectively). Patients with both unfavorable factors had a significantly poorer PFS compared to the remaining patients and a PFS similar to those who had both factors but received only 1 cycle of NACT. In conclusion, the reduction rate of the primary tumor as evaluated by CT following the first cycle of NACT, may aid physicians in determining whether to administer a second cycle. In early non-responders bearing T3 tumors, NACT should be discontinued after the first cycle.

Feasibility of Preoperative Chemotherapy with Docetaxel, Cisplatin, and 5-Fluorouracil versus Adriamycin, Cisplatin, and 5-Fluorouracil for Resectable Advanced Esophageal Cancer

“…In previous studies, we substituted adriamycin for epirubicin in combination with CF (ACF regimen) for neoadjuvant chemotherapy and reported good efficacy [11,13] . Recently, docetaxel plus CF (DCF regimen) has been reported to achieve a notably high response rate in unresectable metastatic gastric cancer and head and neck squamous cell carcinoma [14,15] .…”

Alpha linolenic acid and oleic acid additively down-regulate malignant potential and positively cross-regulate AMPK/S6 axis in OE19 and OE33 esophageal cancer cells

“…Cancers that start in the esophagus are much more common in men than in women and many of these cancers are linked to tobacco or alcohol use, or to excess body weight [23]. Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms [23,24].…”

“…Esophageal tumors usually lead to dysphagia (difficulty swallowing), pain and other symptoms [23,24]. Small and localized tumors can be treated surgically with curative intent [24].…”

Clinical outcomes according to the modified endoscopic criteria for neoadjuvant chemotherapy in resectable esophageal squamous cell carcinoma

“…Clinical trials have shown that neoadjuvant therapy improves the prognosis of patients with ESCC. Furthermore, it is well known that patients with surgically‐resected specimens assessed as having pathological tumor regression after chemotherapy show improved survival rates …”

“…Furthermore, it is well known that patients with surgically-resected specimens assessed as having pathological tumor regression after chemotherapy show improved survival rates. [4][5][6] "The response evaluation criteria in definitive chemoradiotherapy (dCRT) for primary lesion using endoscopy" (dCRT criteria) was developed as part of the Japanese classification of esophageal cancer to specifically determine patients with complete response (CR) after dCRT, which is associated with favorable long-term outcomes (Table S1). 7,8 These criteria have also been applied for the evaluation of primary lesions after nCT.…”