Chemoradiotherapy with FOLFOX for esophageal squamous cell cancer with synchronous rectal cancer: Four case reports and a literature review

Chemoradiotherapy (CRT) is a valuable treatment option for localized esophageal cancer. Conventional baseline chemotherapy for this type of cancer includes cisplatin and fluorouracil. Recently, CRT with leucovorin-fluorouracil-oxaliplatin (FOLFOX) has become popular due to its convenience and lower toxicity. In Japan, the use of oxaliplatin for esophageal cancer is not yet approved, so experience with this treatment is limited to cases with colorectal cancer. As such patients are not usually included in clinical trials, little is known on the efficacy and safety of this treatment for this patient subpopulation, and treatment generalization in Japan is not allowed. We herein share our experience with CRT and FOLFOX for cases with esophageal cancer and synchronous rectal cancer at our institution. The clinical data of 4 patients who were treated for esophageal cancer with CRT/FOLFOX at our hospital between 2007 and 2016, who also had synchronous rectal cancer, were retrieved and analyzed. All the patients were male and had esophageal squamous cell cancer and synchronous rectal cancer. The median patient age was 68 years (range, 65–77 years). One patient received neoadjuvant CRT followed by surgery, and the other 3 patients received definitive CRT for esophageal cancer. FOLFOX was administered biweekly during radiotherapy (41.4–60 Gy). All 4 patients completed the treatment schedule and responded to CRT. No patients experienced progression of rectal cancer during treatment. Notably, 1 patient also achieved a complete response (CR) of rectal cancer after CRT for esophageal cancer. Moreover, 2 patients without dysphagia were treated as outpatients and achieved a CR. Encephalopathy was the only reported grade 3 adverse event. Although the present study included a limited number of cases, the findings suggest that CRT with FOLFOX may be a valuable option for the treatment of patients with esophageal squamous cell cancer and synchronous rectal cancer.