Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6315
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
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).
To investigate the efficacy and safety of NCRT combined with surgery in the treatment of potentially resectable TESCC.
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 and chemotherapy. Surgery was performed after radiotherapy and chemotherapy. The effectiveness and safety of these treatments were observed.
Among these 30 patients, complete response was achieved in 2 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.
In summary, for patients with potentially resectable TESCC, NCRT with paclitaxel combined with lobaplatin plus surgery can effectively reduce the tumor size, increase R0 resection rate, and obviously lower the pathological grading without increasing surgical complications. Paclitaxel combined with lobaplatin has mild toxicities and is worthy of wider clinical application.
Our study was limited by its short follow-up period, and patient survival and tumor recurrence/metastasis need to be further investigated. In addition, the optimal dose and fractionation schedule of the neoadjuvant radiotherapy for ESCC deserve further clinical research.