Long-Term Outcome of Patients with Locally Advanced Clinically Unresectable Esophageal Cancer Undergoing Conversion Surgery after Induction Chemotherapy with Docetaxel Plus Cisplatin and 5-Fluorouracil.

ABSTRACT

BACKGROUND: Although definitive chemoradiotherapy (CRT) is recommended for patients with locally advanced unresectable esophageal cancer, the outcome is unsatisfactory. We previously demonstrated the safety and efficacy of induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil (DCF) and subsequent conversion surgery (CS) for patients with locally advanced unresectable esophageal cancer. However, whether or not induction DCF chemotherapy and subsequent CS improve the long-term outcomes of patients with locally advanced unresectable esophageal cancer is unclear. METHODS: A total of 177 consecutive patients with locally advanced unresectable esophageal cancer without distant metastasis were included in this study. Of these, 55 patients received DCF induction chemotherapy, of whom 36 underwent CS. We divided these 36 patients into two groups according to clinical response, which was analyzed retrospectively. RESULTS: The toxicities related to DCF chemotherapy were manageable. The response rate to induction DCF chemotherapy was 67%. R0 resection was achieved in 81% of the 36 patients who underwent subsequent CS. No serious postoperative complications were observed. Histopathological CR was achieved in 17% of the 36 patients, and the 3- and 5-year survival rates after CS were 61% and 54%, respectively. The outcomes of the patients who obtained good clinical response was better than the outcomes of patients who did not. CONCLUSIONS: Induction DCF chemotherapy and subsequent CS show acceptable toxicity and offer the chance of long-term survival in patients with locally advanced clinically unresectable esophageal cancer.