Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, 880 KitakobayashiShimotsuga-gun, Mibu-machi, Tochigi, 321-0293, Japan.
Department of Surgical Oncology, Dokkyo Medical University Graduate School of Medicine, 880 KitakobayashiShimotsuga-gun, Mibu-machi, Tochigi, 321-0293, Japan.
Gen Thorac Cardiovasc Surg. 2023 Oct;71(10):584-590. doi: 10.1007/s11748-023-01934-7. Epub 2023 Apr 15.
Treatment for borderline resectable (cT3br) esophageal squamous cell carcinoma (SCC) is currently undefined. This study aimed to analyze the outcome of treatment strategies including induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) against T3br esophageal SCC.
A total of 32 patients with cT3br esophageal SCC enrolled in this study were treated with two cycles of DCF induction therapy.
The overall response rate to DCF induction therapy was 62.5%, while the disease control rate was 93.8% (complete response (CR), three; partial response (PR), 17; stable disease (SD), 10; progressive disease (PD), 2). After DCF induction chemotherapy, 27 patients underwent conversion surgery (CS) and five patients underwent definitive chemoradiotherapy (CRT). Out of 27 patients who underwent CS, 17 underwent transthoracic esophagectomy and 10 underwent thoracoscopic esophagectomy. Anastomotic leakage occurred in five patients (18.5%) and pneumonia in four (14.8%). Recurrent laryngeal nerve paralysis and arrhythmia were observed in two patients (7.4%). The R0 resection rate was 81.5%. Among the five patients who underwent definitive CRT, only one patient (20.0%) achieved CR. Two patients (40.0%) had PR and two (40.0%) had PD. Salvage esophagectomy was performed in one patient after definitive CRT. The 1-, 3-, and 5-year overall survival rates were 75.0, 50.6, and 46.4%, respectively, whereas the 1-, 3-, and 5-year disease-free survival rates were 54.9, 38.8, and 38.8%, respectively.
DCF induction therapy and subsequent CS or definitive CRT are promising treatment strategies for cT3br esophageal SCC.
边界可切除（cT3br）食管鳞癌（SCC）的治疗目前尚无定论。本研究旨在分析包括多西紫杉醇、顺铂和 5-氟尿嘧啶（DCF）诱导化疗在内的治疗策略对 T3br 食管 SCC 的疗效。
共纳入 32 例 cT3br 食管 SCC 患者，接受 2 周期 DCF 诱导治疗。
DCF 诱导治疗的总缓解率为 62.5%，疾病控制率为 93.8%（完全缓解（CR）3 例，部分缓解（PR）17 例，稳定（SD）10 例，进展（PD）2 例）。DCF 诱导化疗后，27 例患者接受了转化手术（CS），5 例患者接受了根治性放化疗（CRT）。27 例接受 CS 的患者中，17 例行经胸食管切除术，10 例行胸腔镜食管切除术。吻合口漏发生 5 例（18.5%），肺炎 4 例（14.8%）。喉返神经麻痹和心律失常各 2 例（7.4%）。R0 切除率为 81.5%。5 例接受根治性 CRT 的患者中，仅 1 例（20.0%）达到 CR。2 例（40.0%）为 PR，2 例（40.0%）为 PD。1 例患者在根治性 CRT 后行挽救性食管切除术。1、3、5 年总生存率分别为 75.0%、50.6%和 46.4%，1、3、5 年无病生存率分别为 54.9%、38.8%和 38.8%。
DCF 诱导治疗联合随后的 CS 或根治性 CRT 是治疗 cT3br 食管 SCC 的有前途的治疗策略。
