Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Gastrointest Surg. 2024 Nov;28(11):1745-1751. doi: 10.1016/j.gassur.2024.07.026. Epub 2024 Aug 9.
Neoadjuvant chemoradiotherapy (nCRT) followed by radical esophagectomy is the standard treatment for locally advanced esophageal squamous cell cancer (LA-ESCC). However, various nCRT regimens have been used, and their comparative efficacy and safety remain unclear.
Patients with histologically confirmed LA-ESCC who underwent nCRT followed by radical esophagectomy between January 2016 and February 2022 were enrolled in this study. Of note, 3 different nCRT regimens were retrospectively compared: conventional radiotherapy (RT) + cisplatin/5-fluorouracil (FP) (Conv-FP), hypofractionated RT + FP (Hypo-FP), and regimens from the ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study (CROSS) trial (CROSS). The overall survival (OS), pathologic complete response (pCR), toxicity, and treatment compliance rates were analyzed.
Among the 600 patients, 225 received Conv-FP, 255 received Hypo-FP, and 120 received the CROSS regimen. The OS rates at 1 year were 78.7%, 83.9%, and 88.1% in the Conv-FP, Hypo-FP, and CROSS groups, respectively (P < .001). The pCR rates were 30.6%, 33.9%, and 35.0%, respectively (P = .653). The overall incidence of grade 3 toxicities was 10.2%. Hematologic and nonhematologic toxicities of grade ≥ 3 were observed in 8.4% and 11.4%, 0% and 7.6%, and 5.5% and 0.8% in the Conv-FP, Hypo-FP, and CROSS groups, respectively (P = .002 and P = .030). Weight loss of > 5% was observed in 44.0%, 51.4%, and 32.5% in the Conv-FP, Hypo-FP, and CROSS groups, respectively (P < .001). In the multivariate analysis, clinical T stage (P = .004), N stage (P = .012), FP chemotherapy regimen (P = .013), surgical resection (P < .001), hematologic toxicity (P = .001), and weight loss (P = .004) were significantly associated with poor OS.
The choice of nCRT regimen did not significantly affect the pCR rates in patients with LA-ESCC. However, the CROSS regimen demonstrated better OS and lower toxicity, suggesting that it may be the optimal treatment option among the groups.
新辅助放化疗（nCRT）后行根治性食管切除术是局部晚期食管鳞状细胞癌（LA-ESCC）的标准治疗方法。然而，目前已经使用了各种 nCRT 方案，但其疗效和安全性仍不清楚。
本研究纳入了 2016 年 1 月至 2022 年 2 月期间接受 nCRT 后行根治性食管切除术的经组织学证实的 LA-ESCC 患者。值得注意的是，我们回顾性比较了 3 种不同的 nCRT 方案：常规放疗（RT）+顺铂/5-氟尿嘧啶（FP）（Conv-FP）、低分割 RT+FP（Hypo-FP）和 ChemoRadiotherapy for Oesophageal cancer followed by Surgery Study（CROSS）试验（CROSS）方案。分析了总生存期（OS）、病理完全缓解（pCR）、毒性和治疗依从性。
在 600 例患者中，225 例接受 Conv-FP，255 例接受 Hypo-FP，120 例接受 CROSS 方案。Conv-FP、Hypo-FP 和 CROSS 组的 1 年 OS 率分别为 78.7%、83.9%和 88.1%（P<0.001）。pCR 率分别为 30.6%、33.9%和 35.0%（P=0.653）。总体 3 级毒性发生率为 10.2%。在 Conv-FP、Hypo-FP 和 CROSS 组中，分别有 8.4%和 11.4%、0%和 7.6%、5.5%和 0.8%观察到≥3 级血液学和非血液学毒性（P=0.002 和 P=0.030）。体重减轻>5%的发生率分别为 44.0%、51.4%和 32.5%（P<0.001）。多因素分析显示，临床 T 分期（P=0.004）、N 分期（P=0.012）、FP 化疗方案（P=0.013）、手术切除（P<0.001）、血液学毒性（P=0.001）和体重减轻（P=0.004）与较差的 OS 显著相关。
nCRT 方案的选择并不显著影响 LA-ESCC 患者的 pCR 率。然而，CROSS 方案显示出更好的 OS 和更低的毒性，表明它可能是这些方案中最佳的治疗选择。
