The following is a summary of “Optimizing Organ Preservation Strategies through Chemotherapy-Based Selection in Esophageal Squamous Cell Carcinoma: Results from the CROC Multi-Institutional Phase II Clinical Trial,” published in the July 2024 issue of Oncology by Katada et al.
This study aimed to evaluate the efficacy of definitive chemoradiotherapy (dCRT) as an organ-preservation strategy in patients with remarkable response to induction chemotherapy for resectable esophageal squamous cell carcinoma (ESCC), downstaged to stage IA.
Patients who are chemotherapy-naïve diagnosed with resectable ESCC (stage IB–III, UICC 7th edition) were enrolled. All patients received three cycles of DCF therapy (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and 5-fluorouracil [5-FU] 750 mg/m2 on days 1–5, repeated every three weeks). The remarkable response was defined as tumor reduction to T1, metastatic lymph nodes smaller than 1 cm, and downstaging to stage IA after DCF therapy. Remarkable responders then underwent dCRT consisting of cisplatin 75 mg/m2 and 5-FU 1000 mg/m2 on days 1–4 for two cycles, every four weeks, with concurrent radiotherapy totaling 50.4 Gy. The primary endpoint was 1-year progression-free survival (PFS) in remarkable responders post-DCF therapy and subsequent dCRT. Secondary endpoints included 3-year overall survival (OS) and esophagectomy-free survival (EFS).
Out of 92 registered patients, 90 were analyzed, with 58.4% showing a remarkable response to DCF therapy. Among responders, 89.8% achieved complete response after dCRT. During a median follow-up of 33 months (range: 1–85 months), 1-year PFS was 89.8% (95% CI = 77.2%–95.6%, primary endpoint), and 3-year OS was 83.7%. The 3-year OS and EFS rates were 74.1% and 45.3%, respectively. Additionally, 18F-fluorodeoxyglucose-positron emission tomography response after two DCF therapy cycles significantly correlated with OS (p = 0.0049).
In patients with resectable ESCC, dCRT following a remarkable response to induction DCF therapy represents a viable organ-preservation strategy. This approach optimizes chemotherapy-based selection and demonstrates promising outcomes in terms of PFS, OS, and EFS, supporting its consideration in clinical practice.
Source: sciencedirect.com/science/article/abs/pii/S0360301624007521
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