Abstract Background Neoadjuvant chemotherapy or chemoradiotherapy followed by surgery has been the standard treatment for resectable esophageal squamous cell carcinoma (ESCC). However, definitive chemoradiotherapy (dCRT) remains an option for organ preservation with curative intent. This analysis aimed to compare survival following neoadjuvant chemoradiotherapy followed by surgery (neoCRT) versus dCRT followed by active surveillance and salvage treatment for patients with resectable (T1N1–3 M0 and T2–3NanyM0) ESCC using pooled data from two clinical trials of JCOG0909 and JCOG1109. Methods The neoCRT performed in JCOG1109 included 5-FU (1000 mg/m2 on day1–4, 29–32), cisplatin (80 mg/m2 on day1, 29), and 41.4 Gy followed by surgery. The dCRT performed in JCOG0909 had the same chemotherapy and 50.4 Gy, with active surveillance for a complete response. If the overall response was assessed as an incomplete response, stable disease or progressive disease, salvage treatment was planned. Subgroup analyses of clinical data, including tumor location, cT, cN, serum albumin (Alb), hemoglobin, body mass index, and clinical stage, were conducted on overall survival (OS) and PFS using Cox proportional hazards regression models. Results Ninety-three patients in the dCRT group from JCOG0909 and 191 patients in the NeoCRT group of JCOG1109 were included in this analysis. PFS tended to be better in the neoCRT group than in the dCRT group (PFS, HR 0.82, 95% confidence interval CI 0.58–1.17), though the difference was not significant. OS was nearly identical between the two groups (HR 1.10, 95% CI 0.73–1.65). Among the patients with cT1–2, cN0–1, and Alb ≥4, OS were better in the dCRT group than in the neoCRT group. Conclusion Some subgroups showed better OS outcomes with dCRT compared to neoCRT group, whereas the difference in PFS was less pronounced. Active surveillance and salvage treatment may have influenced these results.
Nomura et al. (Fri,) studied this question.
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