Significance of chemotherapy-free interval and tumor regression grade in patients with recurrent esophageal squamous cell carcinoma receiving chemotherapy with fluorouracil and platinum after esophagectomy following preoperative chemotherapy

Abstract

In Japan, standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC) includes preoperative chemotherapy with fluorouracil plus cisplatin followed by esophagectomy. However, its efficacy is unclear in patients with recurrent disease with\u2009<\u20096 months of chemotherapy-free interval (CFI) after preoperative chemotherapy followed by esophagectomy and in those with\u2009≥\u20096 months of CFI and poor pathological response to prior preoperative chemotherapy. We retrospectively evaluated the efficacy of fluorouracil plus platinum in patients with recurrent ESCC who received preoperative chemotherapy followed by curative esophagectomy. Among 105 patients with recurrent ESCC after preoperative chemotherapy followed by esophagectomy, a total of 55 patients received fluorouracil plus platinum for recurrent disease. Patients with a CFI\u2009<\u20096 months (n\u2009=\u200920) had significantly shorter overall survival (OS) (median, 7.1 vs 14.5 months, P\u2009=\u20090.008) compared with those with a CFI\u2009≥\u20096 months (n\u2009=\u200935). Multivariate analysis showed that OS was worse in patients with a CFI\u2009<\u20096 months or a tumor regression grade (TRG)\u2009≤\u20091a. Furthermore, in patients with a CFI\u2009≥\u20096 months, TRG\u2009≤\u20091a was associated with significantly shorter OS (11.1 months vs. not reached, P\u2009=\u20090.001). Fluorouracil plus platinum was ineffective for recurrent ESCC in patients with a CFI\u2009<\u20096 months and in those with a CFI\u2009≥\u20096 months and a TRG\u2009≤\u20091a. Alternate regimens including nivolumab or pembrolizumab might be considered for the treatment for recurrence in these patients.