Varshney Vaibhav K, Jain Vishu, Selvakumar B, Soni Subhash, Varshney Peeyush, Agarwal Lokesh, Suman Sunita, Varshney Bharti, Hussain Sabir, Goel Akhil Dhanesh, Pareek Puneet, Elhence Poonam
Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
Pathology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
Cureus. 2024 Nov 12;16(11):e73525. doi: 10.7759/cureus.73525. eCollection 2024 Nov.
Neoadjuvant chemoradiation (NACRT) followed by surgery has become the standard of care for esophageal squamous cell carcinoma (ESCC). This study compared the tolerability and oncological benefit of neoadjuvant chemotherapy (NACT) with those of NACRT for the treatment of ESCC.
A prospective quasi-experimental comparative study was conducted from July 2019 to August 2023 to assess the efficacy of the NACT regimen of two cycles of paclitaxel and carboplatin as an alternative to standard NACRT. Either NACT or NACRT was given to patients with resectable ESCC (clinical stage IB-IIIC), after which they underwent minimally invasive esophagectomy with two-field lymphadenectomy. Radiological and pathological responses to neoadjuvant therapy, perioperative morbidity, mortality, and recurrence-free and overall survival rates were compared.
Out of the 74 patients enrolled, 63 were included in the study after exclusion. Of these, 30 received NACT, and 33 received NACRT. The baseline demographics, tumor characteristics, incidence of neoadjuvant therapy-related adverse events, and perioperative morbidity were comparable between the two groups. The median number of lymph nodes retrieved (21 vs 19, p=0.19) and R0 resection rate (100% vs 94%) were similar. Although the pathological response was significantly better in the NACRT arm, at a median follow-up of 32.5 (20.75-48) months, there was a non-significant trend toward better recurrence-free survival in the NACRT group (57 vs 36 months, p-value - 0.831), with median overall survival yet to be achieved in both groups.
Compared with NACRT, NACT for ESCC is well tolerated and has non-inferior oncological outcomes. NACT could be a feasible alternative to NACRT in such patients, especially if the radiotherapy option is not feasible or available.
新辅助放化疗（NACRT）后行手术已成为食管鳞状细胞癌（ESCC）的标准治疗方案。本研究比较了新辅助化疗（NACT）与NACRT治疗ESCC的耐受性和肿瘤学获益。
2019年7月至2023年8月进行了一项前瞻性准实验性比较研究，以评估两周期紫杉醇和卡铂的NACT方案作为标准NACRT替代方案的疗效。对可切除的ESCC（临床分期IB-IIIC）患者给予NACT或NACRT，之后他们接受了微创食管切除术及两野淋巴结清扫术。比较了新辅助治疗的放射学和病理学反应、围手术期发病率、死亡率以及无复发生存率和总生存率。
在纳入的74例患者中，排除后63例纳入研究。其中，30例接受NACT，33例接受NACRT。两组间的基线人口统计学、肿瘤特征、新辅助治疗相关不良事件发生率和围手术期发病率相当。回收的淋巴结中位数（21个对19个，p = 0.19）和R0切除率（100%对94%）相似。虽然NACRT组的病理学反应明显更好，但在中位随访32.5（20.75 - 48）个月时，NACRT组无复发生存率有更好的非显著趋势（57个月对36个月，p值 - 0.831），两组均未达到中位总生存期。
与NACRT相比，ESCC的NACT耐受性良好且肿瘤学结局不差。对于此类患者，NACT可能是NACRT的可行替代方案，特别是如果放疗不可行或无法进行时。
