Efficacy and Tolerance of Two-Course Neoadjuvant Chemotherapy with Cisplatin and 5-Fluorouracil Plus Docetaxel (DCF) for Locally Advanced Esophageal Cancer

<p>Purpose: Three-course neoadjuvant chemotherapy with cisplatin and 5-fluorouracil plus docetaxel (DCF) has become a standard strategy for locally advanced esophageal squamous cell carcinoma. We have used two-course DCF therapy since 2019 because of intolerance to the three-course regimen. The aim of this study is to compare the outcomes of neoadjuvant chemotherapy with two-course DCF with cisplatin and fluorouracil (FP). Methods: A retrospective analysis was performed for patients treated with neoadjuvant chemotherapy and surgical resection for locally advanced esophageal squamous cell carcinoma between April 2016 and March 2022. Cases were divided into those receiving two-course FP therapy (n=15, FP group) and two-course DCF therapy (n=17, DCF group). The primary endpoint was the overall response rate (ORR) and the secondary endpoints were tolerability and recurrence rate. Results: There were no significant differences in background characteristics between the two groups. Grade 3 neutropenia/febrile neutropenia were found in 1/0 cases in the FP group and 6/3 cases in the DCF group. The completion rates of chemotherapy were 100% and 82.3% and the clinical PD/SD/PR/CR of chemotherapy were 2/6/7/0 and 2/1/14/0 in the FP and DCF groups, respectively. ORR (46.7% vs. 88.2%, P=0.021) and the downstaging rate for clinical stage (20.0% vs. 70.6%, P=0.006) were significantly higher in the DCF group, and DCF therapy was associated with a significantly lower recurrence rate within 1 year (30.8% vs. 0%, P<0.036). Conclusion: Two-course DCF therapy for locally advanced esophageal squamous cell carcinoma achieved a high response rate. Furthermore, the treatment strategy of neoadjuvant chemotherapy may contribute to survival benefits due to favorable tolerance.</p>