Efficacy and safety of docetaxel/cisplatin/5-fluorouracil preoperative combination chemotherapy in esophageal cancer patients with extended lymph node metastases

Abstract

Aim We retrospectively investigated the efficacy and safety of combination chemotherapy with 5-fluorouracil (5-FU) and cisplatin plus docetaxel (DCF) as preoperative chemotherapy. Methods One hundred and seven patients were diagnosed with esophageal cancer of clinical stage II and III (except T4) from March 2007 to June 2009. Among these, five patients who had extensive locoregional lymph node metastases underwent preoperative DCF chemotherapy. Results Median age of the five patients was 59 (51-67) years, and all were men with clinical stage III esophageal cancer. The best overall responses were 80% with partial response (PR) and 20% with stable disease (SD). Histological response of grade 1b and more was also 80%. The hematologic toxicities included grade 3 leucopenia in 80% of patients; grade 3 or 4 neutropenia was observed in all patients. Febrile neutropenia occurred in 20% of patients. Nonhematologic toxicities included grade 3 anorexia in 80% of patients. The operations were not postponed due to any adverse events. Postoperative complications included pneumonia, pneumothorax, and cervical lymphatic leakage (one case each). No chemotherapy-related postoperative complications were observed. Median follow-up of surviving patients was 51.5 (33.9-56.4) months. Disease-free survival times were 12.1, 30.9, 48.0, 49.0, and 54.0 months, respectively. Overall survival times were 28.9, 33.9, 51.0, 52.1, and 56.4 months, respectively. Conclusions The response rate of preoperative DCF was 80%, and toxicities were tolerated with support therapies such as granulocyte colony-stimulating factor (G-CSF) and dexamethasone. We therefore concluded that this preoperative treatment might be a promising strategy for patients who have extensive regional lymph node metastases.

Influence of preoperative docetaxel, cisplatin, and 5-fluorouracil on the incidence of complications after esophagectomy for resectable advanced esophageal cancer

“…[3][4][5] A novel regimen that consists of docetaxel, cisplatin, and 5-FU (DCF) is a candidate for NAC against SCCE. 6,7 The superiority of this regimen to FP has already been reported with regard to head and neck cancer, which is biologically similar to SCCE. 8,9 We previously reported the results of 51 patients who received DCF as preoperative chemotherapy (PCT) against SCCE.…”

“…Tanaka et al reported on DCF as NAC for five SCCE patients with clinical stage III disease. 6 The clinical response rate and pathological response rate, defined as a histological response of ≥grade 1b, were both as high as 80%. Watanabe et al 7 reported that the clinical response rate and pathological complete response rate were 60.8% and 11.1%, respectively.…”

“…Tanaka et al . reported on DCF as NAC for five SCCE patients with clinical stage III disease . The clinical response rate and pathological response rate, defined as a histological response of ≥grade 1b, were both as high as 80%.…”

“…Although the incidence of severe complications (Clavien–Dindo classification ≥IV) was significantly higher in the PCT group, DCF treatment was not an independent risk factor. Our applied DCF regimen contained lower doses of cisplatin and 5‐FU than the regimens in other reports because we structured this regimen to minimize adverse events in patients before surgery. On the other hand, we administered a similar dose of docetaxel to that of other studies because we think that docetaxel is the key agent in this regimen.…”

“…A novel regimen that consists of docetaxel, cisplatin, and 5‐FU (DCF) is a candidate for NAC against SCCE . The superiority of this regimen to FP has already been reported with regard to head and neck cancer, which is biologically similar to SCCE .…”