Neoadjuvant Carboplatin/Paclitaxel versus 5-Fluorouracil/Cisplatin in Combination with Radiotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A Multicenter Comparative Study

Abstract

Background: The most beneficial neoadjuvant chemoradiotherapy (nCRT) combination for esophageal squamous cell carcinoma (ESCC) in Asia remains uncertain. Herein, we compared the neoadjuvant carboplatin/paclitaxel (CROSS) regimen versus the cisplatin/5-fluorouracil (PF) regimen in combination with 41.4–50.4 Gy of radiotherapy. Methods: Patients were stratified according to their nCRT regimen: CROSS + 41.4–45.0 Gy (CROSS), PF + 45.0 Gy (PF4500) or PF + 50.4 Gy (PF5040). Propensity score matching by inverse probability of treatment weighting (IPTW) was used to balance the baseline variables. Results: Before IPTW, a total of 334 patients were included. The lowest chemotherapy completion rate was observed in the PF5040 group (76.2% versus 89.4% and 92.0% in the remaining two groups, respectively). Compared with CROSS, both PF groups showed more severe weight loss during nCRT and a higher frequency of post-esophagectomy anastomotic leaks. The use of PF5040 was associated with the highest rate of pathological complete response (45.3%). While CROSS conferred a significant overall survival benefit over PF4500 (hazard ratio [HR] = 1.30, 95% CI = 1.05 to 1.62, p = 0.018), similar survival figures were observed when compared with PF5040 (HR = 1.17, 95% CI = 0.94 to 1.45, p = 0.166). Conclusions: The CROSS regimen conferred a significant survival benefit over PF4500, although the similar survival figures were similar to those observed with PF5040. Considering the lower incidences of severe weight loss and post-esophagectomy anastomotic leaks, CROSS represents a safe and effective neoadjuvant treatment for Taiwanese patients with ESCC.

Survival Outcomes of Patients with Esophageal Cancer Who Did Not Proceed to Surgery after Neoadjuvant Treatment

“…Radiation therapy was delivered between days 8 and 29. The total dose was 41.4–45 Gy, administered in daily fractions of 180 cGy, 5 days per week [ 10 ]. Radiotherapy encompassed the entire esophagus and local regions of lymphoid tissue.…”

Prognostic Effect of the Dose of Radiation Therapy and Extent of Lymphadenectomy in Patients Receiving Neoadjuvant Chemoradiotherapy for Esophageal Squamous Carcinoma

“…Cisplatin plus 5-fluorouracil (PF)-based regimens with an RT dose between 41.4 and 50.4 Gy has proven effective in previous clinical trials and is frequently used in Asia [ 5 , 6 , 7 , 8 ]. Despite the wide range of acceptable RT doses, the doses most commonly used in Taiwan are 45.0 and 50.4 Gy [ 9 ].…”

Unexpected Movement of the Esophagus across the Aorta

“…Rumor regression throughout treatment would induce organ movement [ 1 , 2 , 3 ]. To achieve successful tumor regression, radiation therapy requires several weeks of radiation to be delivered accurately to the tumor [ 4 ]. Usually, a 5–10 mm margin is allowed for set-up error and internal organ motion.…”