Yan MH, Hou XB, Cai BN, Qu BL, Dai XK, Liu F. Neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma. World J Clin Cases 2020; 8(24): 6315-6321 [PMID: 33392312 DOI: 10.12998/wjcc.v8.i24.6315]
Corresponding Author of This Article
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
Research Domain of This Article
Oncology
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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
ARTICLE HIGHLIGHTS
Research 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.
Research motivation
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).
Research objectives
To investigate the efficacy and safety of NCRT combined with surgery in the treatment of potentially resectable TESCC.
Research 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 and chemotherapy. Surgery was performed after radiotherapy and chemotherapy. The effectiveness and safety of these treatments were observed.
Research results
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.
Research conclusions
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.
Research perspectives
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.
