Recurrence Pattern Comparing Preoperative Chemoradiotherapy and Preoperative Chemotherapy with Docetaxel plus 5-Fluorouracil and Cisplatin for Advanced Esophageal Cancer

Abstract

Background. Preoperative chemoradiation therapy (CRT) or chemotherapy (CT) followed by surgery is currently being administered for advanced esophageal cancer. However, few studies have directly compared CRT and CT for treating locally advanced esophageal carcinoma. This study aimed to assess postoperative recurrence patterns and post-recurrence outcomes in patients with radical esophagectomy after CRT or triplet CT regimen with docetaxel, cisplatin, and 5-fluorouracil (DCF). Methods. This study included 325 consecutive patients with thoracic esophageal cancer who received preoperative CRT or DCF followed by curative esophagectomy between January 2010 and December 2019. We compared recurrence patterns after surgery and post-recurrence treatments between CRT and DCF. Locoregional recurrence was defined as recurrences at the primary tumor site or regional lymph nodes. Distant recurrence was defined as non-regional lymph node recurrences, systemic metastases, malignant pleural effusions, or peritoneal metastases. Results: Among 325 patients, 74 received preoperative CF+RT and 251 received preoperative DCF. A propensity score-matched cohort of 53 with CRT and 53 with DCF was included. CRT patients had tumors located in the upper esophagus and had more advanced cancer than DCF patients; however, no differences in patient characteristics were observed in the matched cohort. CRT patients had better histopathological responses and control of locoregional recurrence than DCF patients. On the other hand, distant recurrence, especially in non-regional lymph node, lung, and pleural dissemination, significantly developed more frequently in CRT patients. Furthermore, CRT patients may have received insufficient post-recurrence treatment owing to fewer treatment options. Therefore, although there was no difference in recurrence rate in the two groups, CRT patients had significantly poorer post-recurrence survival than DCF patients Conclusions. Preoperative DCF could reduce distant recurrence after surgery compared to preoperative CRT. The differences in recurrence patterns can be related to the selection of post-recurrence treatment and their prognosis after recurrence.

Clinicopathological Characteristics and Survival Outcomes in Patients with Advanced Esophageal Squamous Cell Carcinoma Who Were Intraoperatively Diagnosed Non-Curative

“…We previously reported that patients undergoing CRT had better histopathological responses and control of locoregional recurrence than patients on DCF, while distant recurrence developed significantly more frequently in patients who underwent CRT. Furthermore, since patients on CRT with R0 resection may have received insufficient post-recurrence treatment owing to fewer treatment options, they had significantly poorer post-recurrence survival than patients on DCF [7]. The present study also showed that patients with preoperative chemotherapy had treatment options for postoperative CRT even after non-curative surgery and has better OS than patients who had preoperative CRT.…”

“…Patients with esophageal cancer generally undergo multidisciplinary management, including surgery, radiotherapy, chemotherapy, and immunotherapy [2][3][4][5]. Preoperative treatment followed by radical surgery, which has a high R0 resection rate, eliminates micro-metastasis, and reduces recurrence risk, has been done to treat advanced esophageal cancer [6][7][8]. Chemoradiotherapy (CRT) or chemotherapy is currently regarded as the standard neoadjuvant treatment for patients with resectable esophageal cancer based on the CROSS trial [9,10] and the JCOG9907 study [11].…”

“…Since most studies related to preoperative treatment or surgery have focused on patients with curative resection [2][3][4][5][6][7][8][9][10][11]17], few studies have investigated patients who underwent non-curative surgery with detailed intraoperative judgment. Therefore, patient characteristics, clinicopathological findings, and survival outcomes in patients undergoing noncurative surgery have not been fully investigated.…”

Clinical Impact of Early Tumour Shrinkage in Metastatic or Unresectable Oesophageal Cancer Treated with Pembrolizumab plus Chemotherapy

“…In patients with metastatic disease, ETS ≥20% was observed in 50% of patients with prior chemoradiation or chemotherapy and 30% of those with adjuvant therapy, similar rates to those in treatment-naïve patients (50%). Although the prognosis of patients with unresectable tumours is extremely poor [33], >90% of patients with unresectable locally advanced disease receive prior treatment, chemoradiation therapy, or surgery, 70% of whom experienced ETS ≥20%. Moreover, univariate analysis showed that treatment history before pembrolizumab plus CF therapy was not associated with PFS (OR 0.97, 95% CI: 0.50–1.91, p = 0.942).…”

Survival Impact of Inflammation-based Prognostic Scores in Metastatic or Unresectable Esophageal Cancer Treated With Pembrolizumab Plus Chemotherapy

“…undergo multidisciplinary management, including surgery, radiotherapy, chemotherapy, and immunotherapy. [2][3][4][5][6][7][8][9][10] However, combination therapy with fluoropyrimidine and platinum-based chemotherapy has been the mainstay firstline treatment for metastatic or unresectable locally advanced esophageal cancer for decades, [11][12][13] with minimal improvement in overall survival (OS).…”