Comparison of the treatment outcomes of different neoadjuvant chemoradiotherapy regimens for resectable locally advanced esophageal cancer

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery Pub Date : 2024-11-01 DOI:10.1016/j.gassur.2024.07.026

Hyunki Park , Kyungmi Yang , Jae Myoung Noh , Young Mog Shim , Hong Kwan Kim , Yong Soo Choi , Jong Ho Cho , Jong-Mu Sun , Hyun Ae Jung , Sehhoon Park , Hana Park , Dongryul Oh

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引用次数: 0

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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比较不同的新辅助化放疗方案对可切除局部晚期食管癌的治疗效果。

背景：局部晚期食管鳞状细胞癌（LA-ESCC）的标准治疗方法是在新辅助化放疗（nCRT）后进行食管根治术。然而，目前已使用了多种 nCRT 方案，其疗效和安全性的比较仍不明确：我们的研究纳入了在2016年1月至2022年2月期间接受nCRT治疗并随后进行根治性食管切除术的组织学确诊LA-ESCC患者。我们对三种不同的nCRT方案进行了回顾性比较：传统放疗（RT）+顺铂/5-氟尿嘧啶（FP）（Conv-FP）、低分次RT+FP（Hypo-FP）和CROSS试验（CROSS）的方案。对总生存率（OS）、病理完全反应率（pCR）、毒性反应和治疗依从性进行了分析：600名患者中，225人接受了Conv-FP治疗，255人接受了Hypo-FP治疗，120人接受了CROSS治疗方案。Conv-FP组、Hypo-FP组和CROSS组1年的OS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）。3级毒性的总发生率为10.2%。在 Conv-FP、Hypo-FP 和 CROSS 中，≥3 级的血液学和非血液学毒性分别为 8.4% 和 11.4%、0% 和 7.6%、5.5% 和 0.8%（p = 0.002 和 0.030）。体重下降大于 5%的患者分别占 44.0%、51.4% 和 32.5%（p < 0.001）。在多变量分析中，临床T分期（p = 0.004）、N分期（p = 0.012）、使用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OS差显著相关：结论：nCRT方案的选择对LA-ESCC患者的pCR率没有明显影响。结论：新辅助化放疗（nCRT）方案的选择对LA-ESCC患者的pCR率没有明显影响，但CROSS方案显示出更好的OS和更低的毒性，表明它可能是各组中的最佳治疗方案：传统放疗（RT）+顺铂/5-氟尿嘧啶（FP）、低分次RT+FP以及CROSS试验的方案。对总生存率（OS）、病理完全反应率（pCR）、毒性和治疗依从性进行了分析。结果显示，nCRT方案的选择对pCR率没有明显影响，但CROSS方案显示出更好的OS和更低的毒性，表明它可能是最佳治疗方案：数据可用性：由于机构数据保护法和患者数据的保密性，数据可用性受到限制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Gastrointestinal Surgery 医学-外科

CiteScore

5.50

自引率

3.10%

发文量

319

审稿时长

2 months

期刊介绍： The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.