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Complete response to definitive chemoradiotherapy in unresectable locally advanced esophageal squamous cell carcinoma

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Abstract

Background

Although definitive chemoradiotherapy (CRT) is the standard therapy for patients with unresectable locally advanced esophageal squamous cell carcinoma (ESCC), poor survival has been reported. Although the complete response (CR) rate is strongly correlated with good prognosis, the predictive factors for CR have not been elucidated.

Methods

This registry study aimed to identify predictors of CR to definitive CRT in patients with unresectable locally advanced ESCC. “Unresectable” was defined as the primary lesion invading unresectable adjacent structures such as the aorta, vertebral body, and trachea (T4b), or the regional and/or supraclavicular lymph nodes invading unresectable adjacent structures (LNT4b).

Results

Overall, 175 patients who started definitive CRT between January 2013 and March 2020 were included. The confirmed CR (cCR) rate was 24% (42/175). The 2-year progression-free survival (PFS) and overall survival (OS) rates of cCR cases vs. non-cCR cases were 59% vs. 2% (log-rank p < 0.001) and 90% vs. 31% (log-rank p < 0.001), with a median follow-up period of 18.5 and 40.5 months, respectively. Multivariate analysis of clinicopathological factors revealed that tumor length ≥ 6 cm [odds ratio (OR) 0.446; 95% CI 0.220–0.905; p = 0.025] was a predictor of cCR.

Conclusions

Favorable PFS and OS rates were observed in patients with cCR. Tumor length was a predictive factor for cCR.

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Acknowledgements

We thank all patients who participated in this study and their families and caregivers and thank the editors and reviewers for reading the manuscript.

Author information

Author notes

  1. Takumi Habu and Ryosuke Kumanishi contributed equally as first authors to this work.

Authors and Affiliations

  1. Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Takumi Habu & Takahiro Kinoshita

  2. Division of Cancer Immunology, Research Institute/Exploratory Oncology Research and Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Japan

    Takumi Habu, Shogo Kumagai, Shohei Koyama & Hiroyoshi Nishikawa

  3. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Takumi Habu & Shuichi Mitsunaga

  4. Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan

    Ryosuke Kumanishi, Takatsugu Ogata, Shigenori Kadowaki & Kei Muro

  5. Division of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan

    Takeshi Fujisawa, Masaki Nakamura & Hidehiro Hojo

  6. Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan

    Saori Mishima, Daisuke Kotani, Takashi Kojima & Hideaki Bando

  7. Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Hisashi Fujiwara & Takeo Fujita

  8. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan

    Tomonori Yano

  9. Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan

    Masahiro Tajika

  10. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan

    Shuichi Mitsunaga

Authors
  1. Takumi Habu
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  2. Ryosuke Kumanishi
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  16. Tomonori Yano
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  17. Masahiro Tajika
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  18. Kei Muro
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  19. Shuichi Mitsunaga
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  20. Takashi Kojima
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  21. Hideaki Bando
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Corresponding author

Correspondence to Hideaki Bando.

Ethics declarations

Ethical Statement

The study was performed according to the Declaration of Helsinki and the Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects. The study protocol was approved by the institutional review boards of the National Cancer Center (2021-222) and the Aichi Cancer Center (2021-0-086).

Conflict of interest

Saori Mishima received honoraria from Merck Serono biopharma, and received research funding from Roche Diagnostics. Daisuke Kotani received honoraria from Takeda, Chugai Pharmaceutical, Lilly, MSD, Ono, Taiho Pharmaceutical, Bristol-Myers Squibb, Daiichi-Sankyo, Pfizer, and Merck Sereno biopharma, and received research funding from Ono Pharmaceutical, MSD, Novartis, Servier, Janssen, IQVIA, Syneos health, and Cmic Shiftzero. Shigenori Kadowaki received honoraria from Eli Lilly, Taiho Pharmaceutical, Ono Pharmaceutical, BMS, Chugai Pharmaceutical,Bayer, Merck Serono, Daiichi Sankyo and Eisai, and received research funding from Taiho Pharmaceutical, Eli Lilly, MSD, Chugai Pharmaceutical, Nobelpharma, Ono Pharmaceutical, Daiichi Sankyo and Yansen. Shohei Koyama received honoraria from Bristol-Myers Squibb, Ono Pharmaceutical, Chugai Pharmaceutical, and MSD, and received research funding outside the scope of this work from Bristol-Myers Squibb, Ono Pharmaceutical and Otsuka Pharmaceutical. Hiroyoshi Nishikawa received research funding and honoraria from Chugai Pharmaceutical, Ono Pharmaceutical, Bristol-Myers Squibb and MSD, and research funding from Taiho Pharmaceutical, Daiichi-Sankyo, Kyowa Kirin, Zenyaku Kogyo, Oncolys BioPharma, Debio pharma, Asahi-Kasei, Sysmex, Fujifilm, Rakuten Medical, SRL, Astellas Pharmaceutical, Sumitomo Dainippon Pharma and BD Japan outside of this study. Kei Muro received honoraria from Ono Pharmaceutical, Taiho Pharmaceutical, Bristol-Myers Squibb, Eli Lilly and Daiichi Sankyo, and received research funding from Taiho, Eisai, Astellas, Amgen, Ono Pharmaceutical, MSD, Novartis, Chugai Pharmaceutical, Sanofi. He also received consulting fees from Astra Zeneca, Ono Pharmaceutical and Amgen. Takashi Kojima received honoraria from Ono Pharmaceutical, Bristol-Myers Squibb, Covidien Japan, MSD, Taiho Pharmaceutical, Oncolys BioPharma, and received research funding from Ono Pharmaceutical, Bristol-Myers Squibb, BeiGene, EPS, MSD, Amgen, Shionogi, Chugai Pharmaceutical, Taiho Pharmaceutical, Parexel international and Merck Biopharma. Hideaki Bando received research funding from Ono Pharmaceutical and honoraria from Taiho Pharmaceutical and Eli Lilly Japan. Hiroyuki Nishikawa is an editorial board member. Takumi Habu, Ryosuke Kumanishi, Takatsugu Ogata, Takeshi Fujisawa, Masaki Nakamura, Hidehiro Hojo, Hisashi Fujiwara, Shogo Kumagai, Takeo Fujita, Takahiro Kinoshita, Tomonori Yano, Masahiro Tajika and Shuichi Mitsunaga declare that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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10388_2023_987_MOESM1_ESM.tif

Supplementary file1 Consort flow diagram of a multicenter retrospective analysis of definitive chemoradiotherapy in patients with unresectable locally advanced esophageal squamous cell carcinoma. (TIF 488 KB)

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Habu, T., Kumanishi, R., Ogata, T. et al. Complete response to definitive chemoradiotherapy in unresectable locally advanced esophageal squamous cell carcinoma. Esophagus 20, 533–540 (2023). https://doi.org/10.1007/s10388-023-00987-0

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