Combined modality treatment of stage II-III esophageal cancer: a single center experience

The purpose of the study was to analyze efficacy and tolerability of combined modality treatment including preoperative chemotherapy with gemcitabine/cisplatin in patients with stage II-III esophageal squamous cell carcinoma. Materials and methods. The study included 70 patients with stage II-III esophageal squamous cell carcinoma. All patients were divided into two groups. Group I (study group) consisted of 35 patients, who received 2 courses of preoperative chemotherapy followed by radical surgery. Group II (control group) comprised 35 patients who underwent surgery alone. The 2-year survival rates were analyzed. Results. Combined modality treatment including preoperative chemotherapy with gemcitabine/cisplatin was well tolerated. The 2-year disease-free survival rates were 71.8% and 39.4% in groups I and II, respectively (р<0.05). The overall 2-year survival rate was 81.3% in patients who received chemotherapy followed by surgery and 51.5% in patients who underwent surgery alone (р<0.05). Conclusion. Compared to surgery alone, combined modality treatment including preoperative chemotherapy with gemcitabine/cisplatin significantly reduced the frequency of local recurrence and distant metastases and increased 2-year survival rate in patients with stage II-III esophageal squamous cell carcinoma, including the presence of unfavorable prognostic factors, such as regional lymph node metastases (N+) and high-grade (G3) squamous cell carcinoma.

esophageal squamous cell carcinoma, combined modality treatment, preoperative chemotherapy, pathological response, short-and long-term treatment outcomes

1. Urmonov U.B., Dobrodeev A. Yu., Afanasyev S. G. et al. Multimodal approaches to the treatment of esophageal cancer. Avicenna bulletin. 2019, Vol. 21, no. 2, pp. 263-8. (In Russ.). DOI: 10.25005/2074-0581-2019-21-2-263-268.@@ Урмонов У. Б., Добродеев А. Ю., Афанасьев С. Г. и соавт. Мультимодальный подход к лечению рака пищевода // Вестник Авиценны. - 2019. - Т 21. № 2. - С. 263-8.

2. Perevodchikova N.I., Gorbunova V. A. Tumor disease chemotherapy guide. M. Prakticheskaya meditsina. 2017; 668 P. (In Russ.)@@ Переводчикова Н. И., Горбунова В. А. Руководство по химиотерапии опухолевых заболеваний. М.: Практическая медицина, 2017. - C. 688.

3. Levchenko E.V., Kanaev S. V., Tyuryaeva E. I. et al. Results of complex treatment of patients with thoracic esophageal cancer. Problems in oncology. 2016, Vol. 62, no. 2, pp. 302-309. (in Russ.)@@ Левченко Е. В., Канаев С. В., Тюряева Е. И. и соавт. Результаты комплексного лечения больных раком грудного отдела пищевода // Вопросы онкологии. - 2016. - Т 62. № 2. - С. 302-309.

4. Sobolev D.D., Mamontov A. S., Homyakov V. M. et al. Results of surgical and combined treatment in patients with thoracic esophageal carcinoma: Ten-year experience of the P. A. Herzen Moscow Oncology Research Institute. P. A. Herzen Journal of Oncology. 2018, no. 4, pp. 4-14. (In Russ.).@@ Соболев Д. Д., Мамонтов А. С., Хомяков В. М. и соавт. Результаты хирургического и комбинированного лечения больных раком грудного отдела пищевода. Опыт МНИОИ им. П. А. Герцена за 10 лет // Онкология. Журнал им. П. А. Герцена. - 2018. - № 4. - С. 4-14.

5. Volkova E.E., Vashakmadze L. A., Homyakov V. M. et al. Accelerated hospital rehabilitation of patients after extended-combined surgeries for cancer of thoracic esophagus and cardia. Siberian journal of oncology. 2013, no. 1, pp. 52-58. (In Russ.).@@ Волкова Е. Э., Вашакмадзе Л. А., Хомяков В. М. и соавт. Ускоренная госпитальная реабилитация больных после расширенно-комбинированных операций по поводу рака грудного отдела пищевода и кардии // Сибирский онкологический журнал. - 2013. - № 1. - С. 52-58.

6. Zhang Y. S., Gao B. R., Wang H. J. et al. Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer: a prospective randomized controlled trial. J. Int. Med. Res. 2010. Vol. 38, no.1, pp. 227-33.

7. Duan X., Yu Z. Neoadjuvant chemoradiotherapy combined with operation vs. operation alone for resectable esophageal cancer: Meta-analysis on randomized controlled trials. Zhonghua Wei Chang Wai Ke Za Zhi. 2017, Vol. 20, no. 7, pp. 809-815.

8. Klevebro F., Ekman S., Nilsson M. Current trends in multimodality treatment of esophageal and gastroesophageal junction cancer - Review article. Surg. Oncol. 2017, Vol. 26, no. 3, pp. 290-295. DOI: 10.1016/j.suronc.2017.06.002.

9. Napier K. J., Scheerer M., Misra S. Esophageal cancer: a review of epidemiology, pathogenesis, staging workup and treatment modalities. World. J. Gastrointest. Oncol. 2014, Vol. 6, no. 5, pp. 112-20. DOI: 10.4251/wjgo.v6.i5.112.

10. Xu X.H., Peng X. H., Yu P. et al. Neoadjuvant Chemotherapy for Resectable Esophageal Carcinoma: A Meta-analysis of Randomized Clinical Trials. Asian Pacific J. Cancer Prev. 2012, Vol. 13, no. 1, pp. 103-110.

11. Samson P., Robinson C., Bradley J. et al. Neoadjuvant Chemotherapy versus Chemoradiation Prior to Esophagectomy: Impact on Rate of Complete Pathologic Response and Survival in Esophageal Cancer Patients. Journal of Thoracic Oncology. 2016, Vol. 11, no. 12, pp. 2227-37.

12. Baba Y., Watanabe M., Yoshida N. et al. Neoadjuvant treatment for esophageal squamous cell carcinoma. World J. Gastrointest. Oncol. 2014, Vol. 6, no. 5, pp. 121-8. DOI: 10.4251/wjgo.v6.i5.121.

13. Klevebro F., Lindblad M., Johansson J. et al. Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry. Br. J. Surg. 2016, Vol. 103, no. 13, pp. 1864-1873. DOI: 10.1002/bjs.10304.

14. Kidane B, Coughlin S, Vogt K et al. Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database Syst. Rev. 2015, Vol. 5, CDC001556.

15. Wang M., Gu J., Wang H. X. et al. Retrospective study of gemcitabine based chemotherapy for unresectable or recurrent esophagus cell carcinoma refractory to first line chemotherapy. Asian Pac. J. Cancer Prev. 2012. Vol. 13, no. 8, pp. 4153-6.

16. Yoshida N., Baba Y., Shigaki H. et al. Risk factors of early recurrence within 6 months after esophagectomy following neoadjuvantchemotherapy for resectable advanced esophageal squamous cell carcinoma. Int. J. Clin. Oncol. 2016, Vol. 21, no. 6, pp. 1071-1078.

17. Little A. G., Lerut A. E., Harpole D. H. et al. The Society of Thoracic Surgeons practice guidelines on the role of multimodality treatment for cancer of the esophagus and gastroesophageal junction. Ann. Thorac. Surg. 2014, Vol. 98, no. 5, pp. 1880-1885.

18. Van Zweeden A. A., van Groeningen C., Honeywell R. J. et al. Vliet Randomized phase 2 study of gemcitabine and cisplatin with or without vitamin supplementation in patients with advanced esophagogastric cancer. Cancer Chemother. Pharmacol. 2018, Vol. 82, no. 1, pp. 39-48.