Clinical Research Papers:
Concurrent cisplatin and 5-fluorouracil versus concurrent cisplatin and docetaxel with radiotherapy for esophageal squamous cell carcinoma: a propensity score-matched analysis
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Peng Zhang1,2,3*, Mian Xi1,2,3*, Qiao-Qiao Li1,2,3*, Yong-Hong Hu1,2,3, Xiaobo Guo4,5, Lei Zhao1,2,3, Hui Liu1,2,3, Shi-Liang Liu1,2,3, Li-Ling Luo1,2,3, Qing Liu6 and Meng-Zhong Liu1,2,3
1 Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
2 Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China
3 Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People’s Republic of China
4 Department of Statistical Science, School of Mathematics & Computational Science, Sun Yat-Sen University, Guangzhou, People’s Republic of China
5 Department of Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia
6 Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
* These authors have contributed equally to this work
Meng-Zhong Liu, email:
Keywords: esophageal cancer, chemoradiotherapy, propensity score, prognostic factor
Received: August 26, 2015 Accepted: April 25, 2016 Published: May 11, 2016
The optimal concurrent chemotherapy regimen with radiotherapy for esophageal cancer is unknown. Here, we compared the survival outcomes and toxicity of definitive chemoradiotherapy with either cisplatin/5-fluorouracil (PF) or docetaxel/cisplatin (DP) in patients with unresectable esophageal squamous cell carcinoma (ESCC). In this study, we identified 317 patients with ESCC who received PF or DP concurrently with definitive radiotherapy. PF group patients received two cycles of cisplatin (60 mg/m2) and 5-fluorouracil (300 mg/m2) at 4-week intervals during radiotherapy. DP group patients received a concurrent three-weekly schedule of docetaxel (60 mg/m2) and cisplatin (80 mg/m2) or cisplatin (25 mg/m2) and docetaxel (25 mg/m2) weekly. The overall survival (OS) and progression-free survival (PFS) were compared using propensity score (–adjusted, –weighted, –stratified, and –matched) analyses. A sensitivity analysis was performed to examine the impact of unmeasured confounders. Inverse probability of treatment weighting for propensity score demonstrated an improvement in OS and PFS with DP group in comparison with PF group (hazard ratio, 0.700; 95% CI, 0.577-0.851) and similar results were achieved with propensity score matching and stratification. Grade 3-4 esophagitis was more common (16/102 vs. 4/102) and grade 3-4 thrombopenia and skin toxicity were less common (3/102 vs. 10/102; 7/102 vs. 19/102; respectively) in the PF group than the DP group. In conclusion, concurrent chemoradiotherapy with the DP regimen resulted in better OS and PFS compared to concurrent PF regimen with tolerable toxicities in ESCC patients. Prospective randomized trials are required to confirm the efficacy of the DP regimen.
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