Clinical significance of the second cycle response to cisplatin-based chemotherapy as preoperative treatment for esophageal squamous cell carcinoma.

BACKGROUND: Repeating two cycles of cisplatin-based chemotherapy is standard protocol for preoperative treatment for advanced esophageal squamous cell carcinoma (ESCC). However, the second cycle of chemotherapy is often less effective than the first.

METHODS: Forty-six patients with advanced ESCC underwent two (41) or one (5) cycle of chemotherapy, consisting of cisplatin, adriamycin, and 5-fluorouracil (5-FU), followed by surgery.

RESULTS: The tumor reduction rates (RR) for the first and second cycles of chemotherapy were 33.3 +/- 22.5% versus 11.5 +/- 42.6%, with the second showing less effectiveness and larger deviation. The second cycle RR was closely correlated with the pathological findings of the surgical specimens, including the effect of chemotherapy, tumor depth, and lymph node metastases, and with postoperative survival rates, which were 75.2% and 26.8% (P = 0.0028) at 3 years for good and poor responders. The first cycle RR showed correlation with neither. The second cycle RR was the only independent prognostic factor among the preoperative parameters in multivariate analysis.

CONCLUSIONS: The second cycle of cisplatin-based chemotherapy in ESCC is less effective, but more closely related with postoperative survival than the first. Treatment other than surgery should be considered for ESCC resistant to second cycle chemotherapy.