Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6315-6321
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6315
Neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma
Mao-Hui Yan, Xiao-Bin Hou, Bo-Ning Cai, Bao-Lin Qu, Xiang-Kun Dai, Fang Liu
Mao-Hui Yan, Bo-Ning Cai, Bao-Lin Qu, Xiang-Kun Dai, Fang Liu, Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China
Xiao-Bin Hou, Department of Thoracic Surgery, The First Medical Center of the Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Yan MH, Qu BL, and Liu F designed the research study; Yan MH, Hou XB, Dai XK, and Cai BN performed the research; Yan MH and Liu F analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of General Hospital of the Chinese People's Liberation Army Institutional Review Board (Approval No. S2017-001-02).
Conflict-of-interest statement: Mao-Hui Yan has received research funding from the Open Project of National Clinical Research Center for Geriatric Diseases (No: NCRCG-PLAGH-2017004); Fang Liu has received research funding from Clinical Research Support Fund of PLA General Hospital (No: 2016FC-CXYY-2004).
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Liu, MD, Chief Doctor, Department of Radiotherapy, The First Medical Center of the Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. liufangfsg@163.com
Received: September 8, 2020
Peer-review started: September 8, 2020
First decision: September 24, 2020
Revised: October 8, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: December 26, 2020
Processing time: 102 Days and 6.3 Hours
Abstract
BACKGROUND

In recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgery has been gradually applied in patients with locally advanced thoracic esophageal cancer, but its effectiveness and safety remains unclear. In this clinical trial, we prospectively investigated the efficacy and safety of NCRT plus surgery in the treatment of thoracic esophageal squamous cell carcinoma (TESCC).

AIM

To investigate the efficacy and safety of NCRT combined with surgery in the treatment of potentially resectable TESCC.

METHODS

Thirty patients with advanced TESCC hospitalized in our hospital from July 2016 to June 2019 were prospectively studied. All patients received NCRT, which included intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f) and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2, 23 for two cycles). Surgery was performed after radiotherapy and chemotherapy. The effectiveness and safety of these treatments were observed. 

RESULTS

Among these 30 patients, complete response was achieved in two cases (6.7%) and partial response in 26 cases (86.7%), yielding an objective response rate of 100%. All patients underwent radical surgery successfully. The R0 resection rate was 100%, and the pathologic complete response rate was 33.3%. The incidence of grade III- IV granulocytopenia was 10% during the NCRT, and anastomotic leakage occurred in one patient after surgery. 

CONCLUSION

For patients with potentially resectable TESCC, NCRT can effectively reduce the tumor size, increase R0 resection rate, and achieve obvious pathological degradation, with mild adverse reactions. Thus, it is worthy of wider clinical application.

Keywords: Esophageal cancer; Neoadjuvant chemoradiotherapy; Surgical treatment; Radiotherapy; Chemotherapy; Toxicity

Core Tip: Esophageal cancer is one of the most common malignant tumors of the digestive system worldwide, with an estimated 572000 new cases and 509000 deaths annually. Treatments for locally advanced esophageal cancer include surgery and radical chemoradiotherapy. Although surgery is one of the mainstream treatments for esophageal cancer, the efficacy of surgery alone is poor. In recent years, neoadjuvant chemoradiotherapy combined with surgery has been gradually applied in patients with locally advanced thoracic esophageal cancer, but its effectiveness and safety remain unclear. In this clinical trial, we prospectively investigated the efficacy and safety of neoadjuvant chemoradiotherapy plus surgery in the treatment of thoracic esophageal squamous cell carcinoma.