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The Role of Adjuvant Chemoradiotherapy Over Radiotherapy After R0 Resection for Stage II-III Esophageal Squamous Cell Carcinoma

Authors Song T, Chen P, Fang M, Zhang X, Du D, Wu S

Received 30 September 2019

Accepted for publication 22 January 2020

Published 5 March 2020 Volume 2020:12 Pages 1631—1639

DOI https://doi.org/10.2147/CMAR.S232930

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo


Tao Song,1,* Peng Chen,2,* Min Fang,1 Xuebang Zhang,3 Dexi Du,4 Shixiu Wu2

1Department of Radiation Oncology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong, People’s Republic of China; 3Department of Radiation Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China; 4Department of Radiation Oncology, The Central Hospital of Lishui City, Lishui, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Shixiu Wu
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 113, Baohe Avenue, Longgang District, Shenzhen, Guangdong, People’s Republic of China
Tel +86-755-66619865
Email wushixiu@medmail.com.cn

Purpose: This study compared the effectiveness and safety of postoperative concurrent chemoradiotherapy (POCRT) containing paclitaxel (PTX) and cisplatin (DDP) with postoperative radiotherapy (PORT) after R0 resection for stage II–III thoracic esophageal squamous cell carcinoma (TESCC).
Materials and Methods: After propensity score matching (PSM) analysis, 87 TESCC patients treated with PORT were matched 1:1 to 87 patients who received POCRT between July 2012 and December 2018. Radiotherapy was delivered at a dose of 200 cGy per day to a total dose of 5000 cGy. Concurrent chemotherapy consisted of DDP (25 mg/m2) for 3 days plus PTX (135 mg/m2) on day 1 every 3 weeks.
Results: Patient- and disease-related characteristics were well-balanced between the two groups. The median overall survival (OS) and disease-free survival (DFS) times were 39.2 and 31.0 months, respectively. The 5-year OS and DFS rates were 31.9% and 19.1% in the PORT group and 45.1% and 35.1% in the POCRT group, respectively. Statistical significance was demonstrated by comparing OS and DFS (P=0.022 and 0.016, respectively). Additionally, subgroup analysis revealed that in node positive TESCC patients, the POCRT group was significantly different from the PORT group regarding OS and DFS (P=0.049 and 0.039, respectively). POCRT decreased distant metastasis over PORT (P=0.044) with manageable toxicities. Multivariate analysis revealed that aside from factors associated with tumor stages, treatment modality was another strong prognostic factor for both OS and DFS (P=0.015 and 0.010, respectively).
Conclusion: Stage II–III TESCC patients could benefit from POCRT with manageable toxicities. Future well-designed prospective studies are highly warranted to confirm the findings in our report.

Keywords: esophageal squamous cell carcinoma, surgery, chemoradiotherapy, survival

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