Efficacy of neoadjuvant chemoradiotherapy with 5-fluorouracil/cisplatin versus paclitaxel/cisplatin in esophageal squamous cell carcinoma: A single-institute real-world study

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) poses a significant health burden globally, particularly in Asian regions, with limited therapeutic options and a challenging prognosis. Neoadjuvant chemoradiotherapy (CRT) has emerged as a primary strategy for managing locally advanced ESCC, although the optimal chemotherapy regimen remains unclear. This study aims to compare the efficacy and safety of two commonly used neoadjuvant chemotherapy regimens, 5-fluorouracil plus cisplatin and paclitaxel plus cisplatin, in patients with locally advanced ESCC. METHODS: This retrospective study included ESCC patients who underwent neoadjuvant CRT, either with 5-fluorouracil/cisplatin or paclitaxel/cisplatin, followed by surgery at a single institution in Taiwan between 2019 and 2022. Treatment-related outcomes, pathological responses, survival analyses, and safety profiles were evaluated and compared between the two chemotherapy groups. RESULTS: Seventy-two patients were analyzed, with 51 (70.8 %) receiving 5-fluorouracil/cisplatin and 21 (29.2 %) receiving paclitaxel/cisplatin. Both groups showed similar rates of downstaging and pathological complete response (pCR). One-year survival rates were 80.4 % for 5-fluorouracil/cisplatin and 90.5 % for paclitaxel/cisplatin. Two-year survival rates were 66.5 % and 60.8 %, respectively. The hazard ratio for overall survival was 0.81 (95 % CI, 0.36-1.79; p = 0.592). No significant differences in toxicity were observed between the groups. CONCLUSION: The study findings suggest that both 5-fluorouracil/cisplatin and paclitaxel/cisplatin regimens demonstrate comparable efficacy and safety profiles as neoadjuvant chemotherapy options for locally advanced ESCC. Decisions regarding the choice of regimen should consider factors such as treatment accessibility, financial costs, and patient preferences. Further research, including randomized controlled trials, is warranted to validate these findings and guide clinical decision-making effectively.