演題抄録

International Workshop

開催概要
開催回
第54回・2016年・横浜
 

Phase Ⅱ study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable esophageal cancer (COSMOS)

演題番号 : IWS3-3

[筆頭演者]
横田 知哉:1 
[共同演者]
加藤 健:2、浜本 康夫:3、坪佐 恭宏:4、小川 洋史:5、伊藤 芳紀:6、原 浩樹:7、宇良 敬:8、小島 隆嗣:9、陳 勁松:10、廣中 秀一:11、盛 啓太:12、長井 祐志:13、浅見 千佳:13、北川 雄光:14

1:静岡県立静岡がんセンター・消化器内科、2:国立研究開発法人国立がん研究センター中央病院・消化管内科、3:慶応義塾大学医学部・消化器内科、4:静岡県立静岡がんセンター・食道外科、5:静岡県立静岡がんセンター・放射線治療科、6:国立研究開発法人国立がん研究センター・放射線治療部、7:埼玉県立がんセンター・消化器内科、8:愛知県がんセンター中央病院・薬物療法部、9:国立研究開発法人国立がん研究センター東病院・消化管内科、10:公益財団法人がん研究会有明病院・消化器内科、11:千葉県がんセンター・臨床試験推進部、12:静岡県立静岡がんセンター・臨床研究支援センター 臨床研究推進室、13:国立研究開発法人国立がん研究センター中央病院・研究支援センター研究推進部、14:慶応義塾大学医学部・一般・消化器外科

 

Background: The standard treatment for locally advanced unresectable esophageal cancer is chemoradiation with cisplatin and 5-fluorouracil (CF-RT). This multicenter phase II trial assessed the safety and efficacy of chemoselection with docetaxel plus cisplatin and 5-fluorouracil (DCF) induction chemotherapy (ICT) and subsequent conversion surgery (CS).
Methods: Patients with clinical T4 and/or unresectable supraclavicular lymph node metastasis were eligible. The treatment started with 3 cycles of DCF-ICT, followed by CS if resectable, or by CF-RT if unresectable. The resectability was re-evaluated at 30Gy-40Gy of CF-RT, followed by CS if resectable, or by completion of 60Gy of CF-RT. If resectable after CF-RT, CS was performed. The primary endpoint was 1-year overall survival (OS).
Results: From April 2013 to July 2014, 48 patients were enrolled. CS was performed in 41.7% (n=20), including DCF-CS (n=18), DCF-CF-RT40Gy-CS (n=1), and DCF-CF-RT60Gy-CS (n=1). R0 resection was confirmed in 19 patients (39.6%). Grade ≧3 postoperative complications included 1 recurrent laryngeal nerve palsy, 1 lung infection, 1 wound infection, 1 pulmonary fistula, and 1 dysphagia; but no remarkable postoperative complications were observed in patients undergoing CS. Clinical complete response after CF-RT was confirmed in 4 patients (8.3%). The estimated 1-year OS was 67.7%. The OS for patients undergoing R0 resection was significantly longer than those without R0 resection. There was 1 treatment-related death in patient receiving DCF-CF-RT60Gy.
Conclusion: Chemoselection with DCF-ICT followed by CS showed promising signs of tolerability and efficacy in patients with locally advanced unresectable esophageal cancer.

キーワード

臓器別:食道

手法別:集学的治療

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