TY - JOUR T1 - Impact of Chemoradiation-induced Myelosuppression on Prognosis of Patients with Locally Advanced Esophageal Cancer After Chemoradiotherapy Followed by Esophagectomy JF - Anticancer Research JO - Anticancer Res SP - 4889 LP - 4895 VL - 35 IS - 9 AU - MASAICHI OHIRA AU - NAOSHI KUBO AU - YOSHITO YAMASHITA AU - KATSUNOBU SAKURAI AU - TAKAHIRO TOYOKAWA AU - HIROAKI TANAKA AU - KAZUYA MUGURUMA AU - KOSEI HIRAKAWA Y1 - 2015/09/01 UR - http://ar.iiarjournals.org/content/35/9/4889.abstract N2 - Background: The prognosis of patients with locally advanced esophageal squamous cell carcinoma (LAESC) is extremely poor. The impact of adverse effects of chemoradiotherapy (CRT), particularly myelosuppression, on postoperative long-term results has remained unclear. Patients and Methods: A total of 44 patients with LAESC who underwent CRT followed by esophagectomy were enrolled. We compared long-term survival by various clinical variables, including myelosuppression (Grade 3 and 4 leukopenia) due to CRT, response to CRT, performance status, postoperative complications, and pathological nodal status. Finally, multivariate analysis of prognostic factors was assessed by the Cox proportional hazards model. Results:The mean age of patients was 62.8 years and the male/female ratio was 32/9. The response rate to CRT was 75% (33/44), which included five cases with complete response and 28 cases with partial response. Grade 3 and 4 leukopenia was 43% (19/44). Mortality and postoperative pneumonia occurred in 3 (7.3%) and 14 cases (31.8%), respectively. Multivariate analysis demonstrated that myelosuppression was a significant negative prognostic factor in overall survival (OS) [hazard ratio (HR)=4.758, p=0.005]. The 5-year OS rate was significantly poorer in the group with myelosuppression than in the group without (15.4% vs. 69.0%, p=0.003). Discontinuation of the preoperative CRT schedule and dose reduction of chemotherapeutic agents was significantly more frequent in the group with myelosuppression than in the group without (p=0.003), and peripheral lymphocyte counts after surgery was significantly lower, which may explain poor prognosis in the group with myelosuppression. Conclusion: Pre-operative CRT-induced myelosuppression has a negative impact on the prognosis of patients with LAESC. Our findings indicate that a careful postoperative follow-up is required for patients who develop myelosuppression after neoadjuvant CRT followed by curative resection for locally advanced esophageal cancer. ER -