本研究旨在评估根治性放化疗 (dCRT) 作为器官保存策略的可行性，适用于可切除食管鳞状细胞癌 (ESCC) 接受诱导化疗后降期至 IA 期的显着反应者。 IB-III 期（UICC，国际癌症控制第 7 版）有资格参加该研究。所有患者均接受三个周期的 DCF 治疗（第 1 天多西紫杉醇 75 mg/m2，第 1 天顺铂 75 mg/m2，第 1-5 天 5-氟尿嘧啶 [5-FU] 750 mg/m2，每三周重复一次）。显着缓解被定义为肿瘤缩小至T1，短轴上转移淋巴结小于1厘米，并且在三个周期的DCF治疗后降期至IA期。然后，反应显着的患者接受了 dCRT，其中包括在第 1-4 天进行两个疗程的顺铂 75 mg/m2 和 5-FU 1000 mg/m2，每四周重复一次，同时进行 50.4 Gy 的放射治疗。主要终点是 DCF 治疗和随后的 dCRT 后显着缓解者的 1 年无进展生存期 (PFS)。次要终点包括 3 年总生存期 (OS) 和无食管切除生存期 (EFS)。在登记的 92 名患者中，对 90 名进行了分析。 58.4% 的患者对三个疗程的 DCF 治疗有显着反应。在这些缓解者中，89.8% 在 dCRT 后达到完全缓解。在 33 个月的中位随访期间（范围：1-85 个月），1 年 PFS 为 89.8%（95% 置信区间=77.2%-95.6%，主要终点），3 年 OS 为83.7%。分析组的 3 年 OS 和 EFS 率分别为 74.1% 和 45.3%。两个疗程 DCF 治疗后的 18F-氟脱氧葡萄糖-正电子发射断层扫描反应与 OS 显着相关 (p=0.0049)。 在可切除的 ESCC 患者中，对于在三个疗程的 DCF 治疗诱导化疗后降期至 IA 期的显着反应者，dCRT 为一种可行的治疗方案，并提供基于化疗的选择的优化器官保存策略。版权所有 © 2024。由 Elsevier Inc. 出版。

This study aimed to assess the viability of definitive chemoradiotherapy (dCRT) as an organ-preservation strategy for remarkable responders who were downstaged to stage IA after receiving induction chemotherapy for resectable esophageal squamous cell carcinoma (ESCC).Chemotherapy-naïve patients with resectable ESCC (stage IB-III, UICC, International Cancer Control 7th edition) were eligible for the study. All patients received three cycles of DCF therapy (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and 5-fluorouracil [5-FU] 750 mg/m2 on days 1-5, repeated every three weeks). A remarkable response was defined as a reduction of the tumor to T1, metastatic lymph nodes smaller than 1 cm on the short axis, and downstaging to stage IA after three cycles of DCF therapy. Remarkable responders then underwent dCRT, which included two courses of cisplatin 75 mg/m2 and 5-FU 1000 mg/m2 on days 1-4, repeated every four weeks, along with 50.4 Gy of concurrent radiotherapy. The primary endpoint was 1-year progression-free survival (PFS) in remarkable responders following DCF therapy and subsequent dCRT. Secondary endpoints included 3-year overall survival (OS) and esophagectomy-free survival (EFS).Of the 92 patients registered, 90 were analyzed. A remarkable response to three courses of DCF therapy was observed in 58.4% of patients. Among these responders, 89.8% achieved a complete response after dCRT. During the median follow-up period of 33 months (range: 1-85 months), the 1-year PFS was 89.8% (95% confidence interval = 77.2%-95.6%, primary endpoint), and the 3-year OS was 83.7%. The 3-year OS and EFS rates in the analysis group were 74.1% and 45.3%, respectively. An 18F-fluorodeoxyglucose-positron emission tomography response after two courses of DCF therapy was significantly associated with OS (p = 0.0049).In patients with resectable ESCC, dCRT for remarkable responders downstaging to stage IA after induction chemotherapy with three courses of DCF therapy is a feasible treatment option and provides an optimizing organ-preservation strategy of chemotherapy-based selection.Copyright © 2024. Published by Elsevier Inc.