Induction chemotherapy followed by chemoradiotherapy with or without consolidation chemotherapy versus Chemoradiotherapy followed by consolidation chemotherapy for Esophageal Squamous Cell Carcinoma

Purpose To compare the efficacy and safety of induction chemotherapy followed by concurrent chemoradiotherapy(I-CCRT), induction chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy(I-CCRT-C), and concurrent chemoradiotherapy followed by consolidation chemotherapy(CCRT-C) for locally advanced esophageal squamous cell carcinoma(ESSC). Methods Patients with locally advanced ESCC who underwent definitive chemoradiotherapy with cisplatin plus fluorouracil or docetaxel from February 2012 to December 2018 were retrospectively reviewed. Kaplan-Meier curve was used to estimate survival. Efficacy was assessed using RECIST, version 1.0. Prognosis factors were identified with Cox regression analysis. Results Patients were treated with CCRT-C(n=59), I-CCRT(n=20), and I-CCRT-C(n=48), SCRT(n=119). The median follow-up duration was 73.9 months for the entire cohort. The ORR of the CCRT-C, I-CCRT, and I-CCRT-C, SCRT groups was 89.8%, 70.0%, and 77.1%, respectively ( P = 0.078). The median PFS in the CCRT-C, I-CCRT, and I-CCRT-C groups was 32.5, 16.1, and 27.1 months, respectively ( P = 0.464). The median OS of the CCRT-C, I-CCRT, and I-CCRT-C groups was 45.9, 35.5, and 54.0 months, respectively ( P = 0.788). Cox regression analysis indicated that I-CCRT and I-CCRT had comparable PFS and OS with CCRT-C( P > 0.05). Neutropenia grade ≥ 3 in CCRT-C, I-CCRT, I-CCRT-C, and SCRT groups was 47.5%, 15%, and 33.3% of patients, respectively( P =0.027). Conclusions I-CCRT and I-CCRT-C using cisplatin plus fluorouracil or docetaxel regimen had comparable outcomes with CCRT-C for locally advanced ESCC. I-CCRT and I-CCRT-C seem to have less severe neutropenia than CCRT-C, and potential to be a standard treatment option for locally advanced ESCC.