Influence of induction chemotherapy and class of cytotoxics on pathologic response and survival after preoperative chemoradiation in patients with carcinoma of the esophagus

BACKGROUND. Patients with localized esophageal cancer (LEC) have diverse outcomes (post-therapy pathologic response, disease-free survival [DFS], and overall survival [OS]) after preoperative chemoradiation (P-CTRT), dictated also by inherent molecular heterogeneity. Whether the type of therapy influences the outcomes remains largely unanswered. It is hypothesized that induction chemotherapy (IC) or the type of cytotoxics used would not influence patient outcomes. METHODS. In this retrospective analysis, consecutive patients with LEC who had P-CTRT were analyzed. Data were collected regarding age, sex, baseline clinical stage, location, type of cytotoxics, post-therapy pathology, DFS, and OS. IC and the type of cytotoxics used were found to be correlated with DFS, OS, and posttherapy pathologic response. RESULTS. A total of 180 patients with LEC (119 had IC before P-CTRT, all had received 5-fluorouracil, 87 had received a taxane, and 57 had received a platinol) were analyzed. The median survival (MS) of all patients was 57.7 months and the 3-year and 5-year OS rates were 65.4% and 46.5%, respectively. The type of therapy appeared to have no influence on the outcome: IC versus no IC (P = .58) or platinol versus taxane versus platinol plus taxane (P = .63). Similarly, the type of pathologic response was not found to be influenced by IC (P = .18) or the type of cytotoxics used (P = .42). The data were similar for DFS. CONCLUSIONS. IC or the type of cytotoxics used with radiation for patients with LEG does not appear to influence OS, DFS, or the type of pathologic response after therapy, suggesting that a plateau has been reached. It remains to be seen whether the use of biochemoradiotherapy can provide an advantage in outcome.