Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Esophagus. 2023 Jan;20(1):109-115. doi: 10.1007/s10388-022-00951-4. Epub 2022 Sep 1.
The standard preoperative treatment for resectable locally advanced esophageal squamous cell carcinoma (LAESCC) in Japan is docetaxel, cisplatin (CDDP), and 5-fluorouracil. However, patients with renal or cardiac dysfunction and elderly patients are ineligible for a CDDP-containing regimen because of toxicities. Oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) therapy has less renal toxicity than CDDP-containing regimens and does not require hydration. However, there are limited data on preoperative FOLFOX therapy in these patients.
This retrospective study analyzed patients with resectable LAESCC who were aged ≥ 75 years or had renal or cardiac dysfunction and received preoperative FOLFOX between 2019 and 2021. FOLFOX was administered every 2 weeks for 3 or 4 cycles and was followed by surgery. Adverse events associated with chemotherapy, the complete resection (R0) rate, relative dose intensity (RDI), and histopathological response were evaluated.
Thirty-five patients were eligible. Median age was 77 (range 65-89) years; 68.6% were aged ≥ 75 years, 74.3% had renal dysfunction, and 17.1% had cardiac dysfunction. The RDI was 70.2% and 87.1% for bolus and continuous intravenous 5-fluorouracil, respectively and 85.2% for oxaliplatin. The most common grade ≥ 3 adverse events were neutropenia (60.0%) and leucopenia (28.6%). Two patients (5.7%) had febrile neutropenia and grade 3 pneumonia. Thirty-one patients underwent surgery. The R0 resection rate was 87.1%, and there was no histopathological evidence of residual tumor in 16.1%. There were no treatment-related deaths.
Preoperative FOLFOX had a manageable safety profile and showed favorable short-term efficacy in patients with resectable LAESCC who were ineligible for CDDP-containing treatment.
在日本，可切除局部晚期食管鳞状细胞癌（LAESCC）的标准术前治疗是多西紫杉醇、顺铂（CDDP）和 5-氟尿嘧啶。然而，由于毒性作用，患有肾功能或心脏功能障碍的患者以及老年患者不符合含 CDDP 方案的条件。奥沙利铂、亚叶酸和 5-氟尿嘧啶（FOLFOX）治疗比含 CDDP 方案的肾毒性更小，且不需要水化。然而，关于这些患者的术前 FOLFOX 治疗的数据有限。
本回顾性研究分析了 2019 年至 2021 年间接受术前 FOLFOX 治疗的可切除 LAESCC 患者，这些患者年龄≥75 岁或患有肾功能或心脏功能障碍。FOLFOX 每 2 周给药 3 或 4 个周期，然后进行手术。评估与化疗相关的不良事件、完全切除（R0）率、相对剂量强度（RDI）和组织病理学反应。
35 名患者符合条件。中位年龄为 77（范围 65-89）岁；68.6%的患者年龄≥75 岁，74.3%的患者有肾功能障碍，17.1%的患者有心脏功能障碍。FOLFOX 中 5-氟尿嘧啶的推注和持续静脉滴注 RDI 分别为 70.2%和 87.1%，奥沙利铂的 RDI 为 85.2%。最常见的≥3 级不良事件是中性粒细胞减少（60.0%）和白细胞减少（28.6%）。有 2 名患者（5.7%）出现发热性中性粒细胞减少和 3 级肺炎。31 名患者接受了手术。R0 切除率为 87.1%，16.1%的患者无残留肿瘤的组织病理学证据。没有与治疗相关的死亡。
术前 FOLFOX 具有良好的安全性，在不适合含 CDDP 治疗的可切除 LAESCC 患者中显示出良好的短期疗效。
