Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion

Manzoni, Giovanni De; Pedrazzani, Corrado; Pasini, Felice; Bernini, Marco; Minicozzi, Anna Maria; Giacopuzzi, Simone; Grandinetti, A.; Cordiano, Claudio

doi:10.1002/jso.20640

Cited by 53 publications

(43 citation statements)

References 33 publications

(50 reference statements)

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“…As shown in Tables 1 and Table 3, seven studies [10][11][12][13][14][15][16] have analyzed the outcome of patients with T4 esophageal cancer who underwent CRT-S. Basically, the combination of 5-FU (200-1000 mg/m 2 ) and CDDP (5-100 mg/m 2 ) was used in all the studies as the primary chemotherapeutic regimen. Although the doses of concurrent radiation varied across studies (36-60 Gy), all CRT in the series were performed as a "planned" treatment before surgical resection.…”

Section: Chemo-radiotherapy Followed By Surgery (Crt-s) Regimenmentioning

confidence: 99%

“…In the survival analysis according to infiltrated organs on pre-treatment staging, Manzoni et al 12) reported that curative resections were possible after CRT (50-60 Gy/ FP) in patients with tumor invasion of the aorta and no long survivors were observed in other categories; the 3-year survival time of patients with invasion of the aorta, airway, and others were 31.3, 4.5, and 0 months, respectively.…”

Section: Tumor Response and Survivalmentioning

confidence: 99%

“…ITT analysis showed median overall resection rate and curative resection (R0) rate for T4 disease of 59% (range, 35%-78%) and 36.5% (range, 32%-44%) respectively; the main reason for the variability is the response to CRT. However, analysis of survival of 51 patients with T4 esophageal tumors according to the infiltrated organ by Manzoni et al 12) indicated that long-term survival might be limited to some, rather than all, patients with T4 tumors who had undergone R0 resection; only patients with infiltration of the thoracic aorta on pre-treatment staging or patients with major response to CRT had a chance of achieving favorable survival. On the other hand, Seto et al 10) showed little benefit for resection of the trachea after CRT (40 Gy/5-FU + CDDP), which is associated with serious complications, even when R0 resection was performed.…”

Section: Commentsmentioning

confidence: 99%

“…8) Previous studies reported the effectiveness of concurrent chemo-radiotherapy (CRT) using this regimen in advanced esophageal cancer including T4 tumors. 9) Thus, two modalities are currently in use for the treatment of esophageal tumors 10,11) ; chemo-radiotherapy followed by surgery (CRT-S) [10][11][12][13][14][15][16] and definitive chemo-radiotherapy (D-CRT). [17][18][19][20][21][22] To the best of our knowledge, there is little or no information on the differences in clinical outcome of patients with T4 esophageal tumors who undergo D-CRT and those who receive CRT-S.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

ATCS

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The outcome of patients with T4 esophageal cancer, defined as a tumor that invades neighboring structures (e.g., aorta, trachea, bronchus, and lung), is extremely poor. Despite recent advances in surgical techniques, these tumors are usually considered inoperable. Two distinct therapeutic options are currently available for T4 esophageal cancers: chemo-radiotherapy followed by surgery (CRT-S), which comprises esophagectomy following down-staging of the tumor by CRT, and definitive chemo-radiotherapy (D-CRT), which is designed to avoid esophagectomy by using maximum doses of irradiation. CRT-S is superior to D-CRT with respect to local control and short-term survival although CRT-S is associated with relatively higher perioperative mortality and morbidity. On the other hand, it is sometimes difficult to achieve local control with D-CRT and the treatment often results in fistula formation, though a complete response to CRT is often associated with better prognosis. Admittedly, the difference in the survival rate between the two modalities is marginal at long-term follow-up due to operative morbidity and inadequate control of distant metastasis in CRT-S. Changes in perioperative management and intensive systemic chemotherapy may enhance the outcome. Randomized controlled trials involving large population samples are needed to define the standard treatment for T4 esophageal cancer.

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Section: Chemo-radiotherapy Followed By Surgery (Crt-s) Regimenmentioning

confidence: 99%

Section: Tumor Response and Survivalmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Makino

Doki

2011

ATCS

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“…Authors concluded, aggressive multimodal therapy with ctrt followed by surgery in cT4 SCC of the thoracic esophagus is feasible. Surgery should be limited to patients with significant response to induction treatment and a high probability of R0 resection [8].…”

Section: Resultsmentioning

confidence: 99%

Comparison Between Concurrent Chemoradiation Followed by Surgery vs. Surgery for Locally Advanced Cancer of Esophagus

et al. 2010

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Surgery is an accepted standard in the treatment of localized stage cancer of esophagus. But the ideal approach for locally advanced lesions still remains unknown. Patients with locally advanced lesions (cT3-4N1M0) on the basis of CT chest were subjected either to primary surgery or to preoperative chemoradiation followed by surgery. Major postoperative complications (mortality, anastomotic leak and recurrent laryngeal nerve palsy) did not differ in either arm (P = not significant). Complete pathological response was achieved in 31.2% cases in multimodality arm. Four year overall survival was 10% for whole group. Median survival was 14 months and 20 months in surgery and multimodality arm, respectively (p = .288). In multimodal arm, there was significant survival difference between complete responders and nonresponders (p = .02). For locally advanced lesions, surgery alone gives poor outcome and preoperative chemoradiation followed by surgery should be considered for complete responders.

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Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

Makino

Yamasaki

Miyazaki

et al. 2018

Annals of Gastroent Surgery

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Background Survival of patients with cT4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for cT4 esophageal cancers: definitive chemoradiation (dCRT) and induction treatment followed by conversion surgery (CS). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with dCRT and those eventually treated with CS. Methods A systematic search of the scientific literature on PubMed/MEDLINE was carried out using the keywords “T4 esophageal cancer,” “invading (involving) adjacent organ,” “definitive chemoradiation,” “induction therapy,” “salvage surgery,” and “conversion surgery,” obtaining 28 reports published up to July 2018. Results/Conclusion We found that CS was superior to dCRT with respect to local disease control and short‐term survival; however, CS was associated with relatively higher perioperative mortality and morbidity. Alternatively, although dCRT might often cause fistula formation, a clinical complete response to dCRT is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5‐fluorouracil (DCF), which has shown promise as an initial induction treatment for cT4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative CRT. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for cT4 esophageal cancer.

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Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion

Abstract: Aggressive multi-modal therapy with CRT followed by surgery in cT4 SCC of the thoracic esophagus is feasible. Surgery should be limited to patients with significant response to induction treatment and a high probability of R0 resection.

Cited by 53 publications

References 33 publications

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Treatment of T4 Esophageal Cancer. Definitive Chemo-Radiotherapy vs Chemo-Radiotherapy Followed by Surgery

Comparison Between Concurrent Chemoradiation Followed by Surgery vs. Surgery for Locally Advanced Cancer of Esophagus

Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

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