In borderline resectable ESCC, neoadjuvant CRT is tied to benefit

  • Suzuki T & al.
  • Ann Surg Oncol
  • 9 Dec 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Neoadjuvant chemoradiotherapy (NACRT) with cisplatin and fluorouracil led to a 44% R0 resection rate in borderline resectable esophageal squamous cell carcinoma (BR-ESCC).

Why this matters

  • There are limited data on treatment strategies for BR-ESCC.

Study design

  • Retrospective analysis of patients who underwent NACRT with cisplatin plus fluorouracil and irradiation (40 Gy, n=50).
  • Funding: None disclosed.

Key results

  • 44% of patients achieved clinical curative resection (R0 group).
  • The R0 group had a longer median OS:
    • 2.4 vs 0.8 years;
    • HR, 0.29 (P<.01>
  • 27 patients underwent surgery after NACRT:
    • 14 underwent 1 course of chemotherapy, and 11 (79%) achieved R0 resection; 
    • 13 underwent 2 courses of chemotherapy, and 11 (85%) achieved R0 resection.
  • Patients with higher pre-NACRT serum squamous cell carcinoma (SCC) antigen levels (>2 ng/mL) had:
    • Worse OS: 0.8 vs 2.5 years (HR, 5.4; P<.01>
    • A trend toward worse relapse-free survival: 0.4 vs 1.8 years (HR, 2.43; P=.22).
  • Pre-NACRT higher serum SCC antigen level was associated with non-R0 resection (OR, 8.62; P<.01 as was pre-nacrt clinical nodal involvement p=".02).</li">
  • On multivariate analysis, high serum SCC antigen level predicted worse survival: HR, 7.03 (P<.01>

Limitations

  • Japanese patient population.
  • Retrospective design.