Induction chemotherapy followed by chemoradiotherapy for T4M0 esophageal cancer

Purpose In Japan, chemoradiotherapy (CRT) is primarily indicated for T4 esophageal cancer for curative intent or when aiming for downstaging. However, CRT yields a low rate of complete response, is associated with a high incidence of complications such as fistula, and often results in the emergence of severe lymph node metastasis or distant organ metastasis after the therapy. A safer and more effective treatment strategy is needed. The aim of this study is to evaluate the efficacy of the combination of induction chemotherapy and subsequent CRT for T4M0 esophageal squamous cell carcinoma. Patients and methods In our institute, 97 consecutive patients with T4M0 esophageal cancer underwent CRT between 2000 and 2007. Of these, 47 patients who received induction chemotherapy before CRT were eligible for the present retrospective analysis. The regimen of induction chemotherapy was FAP therapy (fluorouracil 700 mg/m2/ day, cisplatin 14 mg/m2/day on days 1–5, doxorubicin 30 mg/m2/day on day 1) administered every 4 weeks. After one to five courses of FAP therapy, concurrent CRT at a dose of 60–66 Gy in 30–33 fractions was undergone. Results Induction chemotherapy, which preceded CRT, was effective in 21 patients (47%; responder) and ineffective in the remaining 26 patients (47%; non-responder). Better survival was achieved in the responder than in the non-responder group: the mean survival time (MST) and 1-year survival rate were 14.3 months and 66.7%, respectively, in the former, and 9.1 months and 33.6%, respectively, in the latter group. Treatment-related death occurred in 3 (6%) of the 47 patients receiving induction chemotherapy because of the progression of the radiation pneumonitis. Conclusion Induction chemotherapy followed by CRT is expected to improve the survival rate without increasing severe therapy-associated complications in patients with T4M0 esophageal cancer.