Outcomes of preoperative chemotherapy with docetaxel, cisplatin, and 5-fluorouracil followed by esophagectomy in patients with resectable node-positive esophageal cancer.

BACKGROUND

There is a consensus that neoadjuvant therapy is an essential component of treatment for resectable advanced esophageal cancer. The aim of this study was to evaluate the efficacy of preoperative docetaxel/cisplatin/5-fluorouracil (DCF) followed by esophagectomy for patients with node-positive esophageal cancer using a prospective database.

METHODS

Fifty-five consecutive patients with resectable node-positive esophageal cancer were treated with preoperative DCF between August 2008 and December 2010. Of these patients, 54 completed 2 courses of DCF, and 50 underwent esophagectomy after the planned chemotherapy. Clinical and pathologic responses to DCF were investigated, as was patient prognosis. Cox proportional hazard regression was used to determine factors that independently affected recurrence.

RESULTS

Complete response, partial response, stable disease, and progressive disease were observed in 5, 24, 24, and 2 patients, respectively. Overall, the clinical response rate was 53 %. Pathologic complete response was achieved in 6 cases (12 %), and the overall pathologic response rate was 36 %. Downstaging was observed in 23 cases (46 %). Two-year overall and disease-free survival rates were 78 and 56 %, respectively. Multivariate analysis revealed that residual tumor [R1/2; hazard ratio (HR) 5.21, 95 % confidence interval (CI) 1.64-17.2], pathologic poor response (grade 1a; HR 3.08, 95 % CI 1.08-11.1), and ypN (M1Lym; HR 13.3, 95 % CI 2.06-116) were independent predictors of recurrence.

CONCLUSIONS

DCF has strong antitumor activity for esophageal cancer and may confer survival benefits when used as preoperative chemotherapy.