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

Abstract

Background: Neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma (ESCC) requires reassessment. We have conducted a trial aiming at the comparison between DCF and ACF concerning perioperative adverse events. Methods: Patients were randomly assigned to receive either DCF [docetaxel 70 mg/m², cisplatin 70 mg/m² on day 1, and 5-fluorouracil (5-FU) 700 mg/m² for 5 days] every 3 weeks or ACF (adriamycin 35 mg/m², cisplatin 70 mg/m² on day 1, and 5-FU 700 mg/m² for 7 days) every 4 weeks. Each group consisted of 81 patients. Two cycles of preoperative chemotherapy were planned, after which patients underwent subtotal esophagectomy via a right thoracotomy with lymphadenectomy. Chemotherapy- and surgery-related adverse effects were assessed. Results: Grade 3-4 neutropenia and febrile neutropenia occurred in 90 and 39% of patients, respectively, in the DCF group compared with 69 and 17% of patients, respectively, in the ACF group (p < 0.01). Perioperative complications did not differ significantly between the groups. The overall response rates of DCF and ACF were 61 and 40%, respectively, while the histopathological complete responses were 15 and 3%, respectively (p < 0.01). Conclusion: The DCF and ACF regimens were found to be equally feasible in patients with resectable advanced ESCC; however, DCF delivered an antitumor effect and therefore potentially improved the long-term outcomes.

Skeletal Muscle Loss during Neoadjuvant Chemotherapy Is an Independent Risk Factor for Postoperative Infectious Complications in Patients with Advanced Esophageal Cancer

“…5-Fluorouracil was administered at a dose of 700 mg/m 2 by continuous infusion on days 1 through 5 [7,8]. Prophylactic antibiotics or granulocyte colony-stimulating factor were not provided.…”

“…The patients were scheduled for surgery approximately 4 weeks after the last day of the chemotherapy. The surgical procedure consisted of transthoracic subtotal esophagectomy with 2-or 3-field lymphadenectomy and reconstruction using the stomach, jejunum, or colon [6][7][8].…”

“…We have recently been performing triplet chemotherapy (docetaxel combined with cisplatin and 5-fluorouracil; DCF therapy) as NACT. We previously reported that although DCF therapy has powerful antitumor effects, this regimen is associated with a high incidence of severe toxicities, such as neutropenia, diarrhea, and febrile neutropenia [7,8]. Severe toxicities may influence body composition, including skeletal muscle mass, and increase postoperative complications.…”

Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

“…Indeed, DCF had a strong antitumor effect for ESCC, and it is currently being used as a first‐line chemotherapy regimen for ESCC. DCF even achieved local tumor control comparable to that achieved with CRT; thus, several studies used DCF as an initial induction treatment for T4 ESCC and confirmed its clinical utility. A recent phase II study (COSMOS trial) investigated the efficacy of induction DCF chemotherapy.…”

“…Recently, new triplet chemotherapy regimens have been reported to yield high response rates for esophageal squamous cell carcinoma (ESCC) . In particular, docetaxel plus CF (DCF) was shown to be more effective for treating ESCC than the standard treatment of CF or CF plus adriamycin (ACF) .…”