The concurrent chemoradiotherapy followed by surgery is the standard treatment for locally advanced esophageal cancer (LAEC) and the role of induction chemotherapy (IC) remains unclear. We aimed to study if the addition of IC to standard treatment increases the rate of pathologic complete response (pCR).
We assembled a retrospective analysis of patients (pts) diagnosed with LAEC and treated with preoperative chemoradiotherapy followed by esophagectomy (CRT+S), preceded or not by IC, between 2009 and 2017. Patients’ characteristics, tumor variables and treatment outcomes were evaluated. Kaplan-Meier method was used to estimate overall survival and Cox proportional hazard model to evaluate prognostic factors.
103 pts were studied, with a median age of 62 years (range 37-84). Seventy-five pts (73%) were male, 67 (65%) had squamous cell carcinoma and 31 (30%) adenocarcinoma. Forty-three pts (41,7%) received IC followed by CRT+S (IC+CRT+S). The most frequent IC consisted of paclitaxel and platinum (38 pts – 90%) and the median number of cycles was 2 (range 1-6). All pts received CRT+S. Concurrent chemotherapy was a combination of paclitaxel and platinum in 94 pts (91%). The median radiation dose was 41.4 Gy (range 39.6-50.4). There was no statistically significant difference in pCR between the IC group and the standard CRT+S group. The pCR was 41.9% and 46.7% in the IC+CRT+S and CRT+S group (p = 0,628), respectively. In the multivariate analysis, pCR was an independent prognostic factor for failure free survival (FFS) (HR 0.35, 95% CI 0.14-0.85, p = 0.021), but not for overall survival (OS) (p = 0.863). The factor that significantly affected OS in the multivariate analysis was positive lymph node (HR 5.9, 95% CI 1.23-28.27, p = 0.026). IC, histology, histologic grade, radiation dose, T stage were not identified as independent prognostic factors for neither OS nor FFS.
Our data suggest that the addition of IC to standard CRT+S does not increase the pCR rate in LAEC. No difference in OS was observed between pts that received or not IC. Regardless of the treatment received, pts achieving a pCR presented improved FFS.
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All authors have declared no conflicts of interest.