Taiichiro Kosaka, Shun Yamaguchi, Koji Natsuda, Shinichiro Kobayashi, Satomi Okada, Kengo Kanetaka, Chika Sakimura, Yasuhiro Torashima, Tomohiko Adachi, Kazuma Kobayashi, Shinichiro Ito, Takahiro Enjoji, Sayaka Kuba, Akira Yoneda, Hanako Tetsuo, Masaaki Hidaka, Mitsuhisa Takatsuki, Yuusuke Inoue, Susumu Eguchi, Kosho Yamanouchi, and Shinichiro Ono
Background In Japan, two courses of CDDP+5-FU (CF) therapy followed by surgery is accepted as a standard treatment for stage II/III esophageal cancer (EC) based on the results of the JCOG9907 trial. However, in some cases, especially stage III disease, the anti-tumor effect of CF is insufficient. Therefore, a three-arm phase III trial (neoadjuvant [NAC] setting: CF vs. CF+radiation vs. DOC+CF [DCF]) is on-going. We have aggressively performed DCF therapy mainly in NAC settings since October 2014. We herein review the outcomes of DCF therapy. Methods Twenty-three patients (20 men, 3 women; median age: 70.0 years) with stage III or IV EC who received DCF therapy (October 2014 to February 2018) were retrospectively reviewed. Results The response rate was 43.5%. Down-staging was achieved in 11 patients (47.8%) over the course of treatment. Twenty-one patients transited to surgery, and 20 of them underwent R0 resection. One patient with disease progression was converted to chemoradiation therapy. Histological efficacy was observed in 21 patients, including 7 cases of grade 2. Those treated with DCF therapy who achieved down-staging had a significantly longer relapse-free survival (RFS) than those without down-staging (median RFS: not reached vs. 167 days, p = 0.0011) and also tended to have a longer overall survival (OS) than those without down-staging (MST: not reached vs. 824 days, p = 0.0637). Patients receiving CF therapy with down-staging tended to show a better RFS and OS than those without down-staging, although not to a significant degree. Patients receiving DCF therapy with grade ≥1b histological efficacy tended to have a longer RFS than those with grade Conclusions These findings suggest that down-staging and the histological efficacy might be predictive factors for DCF therapy for EC.