A Retrospective Cohort Study Comparing Neoadjuvant Chemotherapy vs. Neoadjuvant Chemoradiotherapy for Patients with Locally Advanced Thoracic Esophageal Squamous Cell Carcinoma

Background : Based on results from the Japan Clinical Oncology Group (JCOG) 9204 and JCOG 9907 trials, neoadjuvant-CF (cisplatin+5-fluorouracil) followed by esophagectomy with extended lymphadenectomy is the standard treatment for patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC) in Japan. Recently, however, results from the JCOG 1109 trial revealed that neoadjuvant-DCF (docetaxel+cisplatin+5-fluorouracil) provides significantly better overall survival (OS) than neoadjuvant-CF, whereas neoadjuvant chemoradiotherapy (NACRT) did not produce significantly better outcomes than neoadjuvant-CF.Methods : We retrospectively identified 225 ESCC patients treated between December 2008 and December 2021 who received esophagectomy at Akita University Hospital. These patients were divided into neoadjuvant-CF (NAC, n=30) and NACRT (NACRT, n=195) groups before esophagectomy. Using the Kaplan-Meier method, we compared OS and disease-specific survival (DSS) between the two groups.Results : The pathological response to treatment was significantly better in the NACRT than the NAC group. Although 5-year OS and DSS were better in the NACRT than NAC group, these differences did not reach statistical significance.Conclusion : Among patients with locally advanced thoracic ESCC, NACRT produced a significantly better pathological response than NAC. However, NACRT did not produce significantly better long-term survival than NAC, which is consistent with the results of JCOG 1109