Concurrent Chemoradiotherapy with Docetaxel, Cisplatin, and 5-fluorouracil Improves Survival of Patients with Advanced Esophageal Cancer Compared with Conventional Concurrent Chemoradiotherapy with Cisplatin and 5-fluorouracil

• Published in: Journal of Cancer Vol. 9; no. 16; pp. 2765 - 2772
• Main Authors: Tamaki, Yukihisa, Hieda, Yoko, Nakajima, Masanobu, Kitajima, Kazuhiro, Yoshida, Rika, Yoshizako, Takeshi, Ue, Atsushi, Tokudo, Mutsumi, Hirahara, Noriyuki, Moriyama, Ichiro, Kato, Hiroyuki, Inomata, Taisuke
• Format: Journal Article
• Language: English
• Published: Australia Ivyspring International Publisher 01.01.2018
• Subjects: Research Paper; 5-fluorouracil; overall survival; esophageal cancer; cisplatin; concurrent chemoradiotherapy; docetaxel
• ISSN: 1837-9664; 1837-9664
• DOI: 10.7150/jca.23456

To compare treatment outcomes and adverse events between concurrent chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) and conventional concurrent chemoradiotherapy with cisplatin and 5-fluorouracil (CF-RT). We retrospectively investigated treatment outcomes and adverse events in 121 patients with advanced esophageal cancer who underwent concurrent chemoradiotherapy with CF-RT (n = 83) or DCF-RT (n = 38). In the CF-RT group, patients were administered cisplatin (70 mg/m ) and 5-fluorouracil (700 mg/m ) for 5 days; in the DCF-RT group, patients were administered docetaxel (50 mg/m ), cisplatin (50 mg/m ), and 5-fluorouracil (500 mg/m ) for 5 days. The radiotherapy dose was 1.8-2 Gy per session, up to a total of 50-60 Gy. The complete response (CR) rate was 37.8% in the CF-RT group and 52.6% in the DCF-RT group. Overall survival (OS) rates at 2 and 3 years were 45.0% and 37.5%, respectively, in the CF-RT group and 62.9% and 56.7%, respectively, in the DCF-RT group, with a significant intergroup difference (p = 0.032). Progression-free survival rates at 2 and 3 years were 44.1% and 36.9%, respectively, in the CF-RT group and 45.0% and 45.0%, respectively, in the DCF-RT group (p = 0.10). Local control rates at 2 and 3 years were 59.1% and 54.6%, respectively, in the CF-RT group and 71.8% and 71.8%, respectively, in the DCF-RT group (p = 0.12). The incidence of Grade 3/4 leukopenia was 55.4% (n = 46) in the CF-RT group and 78.9% (n = 30) in the DCF-RT group, with a significant intergroup difference (p = 0.022). The incidence of Grade 3/4 neutropenia was 47.0% (n = 39) in the CF-RT group and 65.8% (n = 25) in the DCF-RT group, with a notable albeit not statistically significant difference between the groups (p = 0.054). There were no significant intergroup differences in anemia, thrombocytopenia, radiation-induced dermatitis, radiation esophagitis, or late adverse events. Rates of OS and CR were improved after treatment with DCF-RT compared with CF-RT. Although DCF-RT-treated patients had higher rates of leukopenia, treatment safety was ensured through proper management of myelotoxicity. DCF-RT is a promising treatment regimen for advanced esophageal cancer.