Chemoradiotherapy in the Management of Locally Advanced Squamous Cell Carcinoma Esophagus: Is Surgical Resection Required?

Rawat, Sheh; Kumar, Gaurav; Kakria, Anjali; Sharma, Manoj Kumar; Chauhan, Deepika

doi:10.1007/s12029-013-9477-7

Cited by 23 publications

(13 citation statements)

References 37 publications

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“… 17 Recent studies have demonstrated that postoperative adjuvant chemoradiotherapy significantly improves the long-term survival of patients with EC compared with surgery alone. 30 , 31 However, no significant difference was found regarding 5-year CSS in adjuvant therapy in our study (40.8% vs 38.5%, P = 0.458). Two possible reasons were as follows: Firstly, the postoperative adjuvant chemoradiotherapy was not mandatory in our study.…”

Section: Discussioncontrasting

confidence: 65%

Lymphopenia Predicts Poor Prognosis in Patients With Esophageal Squamous Cell Carcinoma

2014

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Lymphopenia is a useful predictive factor in several cancers. The aim of this study was to determine the prognostic value of lymphopenia in patients with esophageal squamous cell carcinoma (ESCC).A retrospective analysis of 307 consecutive patients who had undergone esophagectomy for ESCC was conducted. In our study, a lymphocyte count (LC) of fewer than 1.0 Giga/L was defined as lymphopenia. Kaplan–Meier method was used to calculate the cancer-specific survival (CSS). Cox regression analyses were performed to evaluate the prognostic factors. Receiver operating characteristic (ROC) curve was also plotted to verify the accuracy of LC for CSS prediction.The mean LC was 1.55 ± 0.64 Giga/L (range 0.4–3.7 Giga/L). The incidence of lymphopenia (LC < 1.0 Giga/L) was 16.6% (51/307). Patients with lymphopenia (LC < 1.0 Giga/L) had a significantly shorter 5-year CSS (21.6% vs 43.8%, P = 0.004). On multivariate analysis, lymphopenia (LC < 1.0 Giga/L) was an independent prognostic factor in patients with ESCC (P = 0.013). Lymphopenia had a hazard ratio (HR) of 1.579 [95% confidence interval (CI): 1.100–2.265] for CSS. ROC curve demonstrated that lymphopenia (LC < 1.0 Giga/L) predicts survival with a sensitivity of 86.2% and a specificity of 27.2%.Lymphopenia (LC < 1.0 Giga/L) is still an independent predictive factor for long-term survival in patients with ESCC.

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Section: Discussioncontrasting

confidence: 65%

Lymphopenia Predicts Poor Prognosis in Patients With Esophageal Squamous Cell Carcinoma

2014

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“…Rawat et al . selected patients who underwent concurrent CRT (50 Gy, 40 mg/m 2 of cisplatin per week) and evaluated the therapeutic effect after six weeks . Patients with resectable tumors underwent surgery, while the remainder was classified as the observation group (active surveillance).…”

Section: Discussionmentioning

confidence: 99%

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

et al. 2018

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BackgroundAlthough a clinical complete response (cCR) after chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a following strategy, such as surgical or non‐surgical approach, remains controversial.MethodsAll articles relevant to a comparison of surgical and non‐surgical treatment (including further definitive chemoradiotherapy or active surveillance) for esophageal carcinoma patients with a cCR after CRT were retrieved for meta‐analysis. The final date for data retrieval was 30 June 2018.ResultsFour retrospective studies including 648 patients met the inclusion criteria: 620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT + surgery group had an advantage over the non‐surgery group in regard to two‐year disease‐free survival (DFS); however, the two groups showed similar results in five‐year DFS. The CRT + surgery group had an advantage over the non‐surgery group in two‐year overall survival (OS); nevertheless, the two groups showed similar results in five‐year OS.ConclusionsBased on the available evidence, the addition of surgery to thoracic locally advanced esophageal carcinoma patients with a cCR after neoadjuvant CRT provided no advantage to long‐term survival. As an exception, the two‐year DFS and OS could be improved. This research conclusion might be more suitable to patients with squamous cell carcinoma.

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“…Recent trials, including CROSS, MAGIC, ACCORD and OEO2, have established neoadjuvant therapy as standard of care for locally advanced esophageal cancer [ 23 – 27 ]. In addition, studies have demonstrated that postoperative adjuvant chemoradiotherapy significantly improves the long-term survival of patients with EC compared with surgery alone [ 28 , 29 ]. However, the current study was a retrospective study between 2005 and 2008, the preoperative adjuvant radiotherapy and/or chemotherapy was controversial at the time.…”

Section: Discussionmentioning

confidence: 99%

A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: neutrophil lymphocyte ratio/albumin ratio

2017

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BackgroundWe initially proposed a novel inflammation-based prognostic index, named neutrophil lymphocyte ratio/albumin ratio (NLR/Alb), for predicting the postoperative survival in esophageal squamous cell carcinoma (ESCC).Materials and methodsA retrospective study of 329 cases with resectable ESCC was included. The optimal cut-off values were evaluated by X-tile program. The 5-year cancer-specific survival (CSS) was calculated by Kaplan–Meier method. Cox regression analyses were performed to evaluate the prognostic factors.ResultsThe optimal cut-off value was 0.1 for NLR/Alb according to the X-tile program. There was a significantly better 5-year CSS in patients with NLR/Alb ≤ 0.1 than patients with NLR/Alb > 0.1 (39.1% vs. 11.0%, P < 0.001). According to multivariate analyses, NLR/Alb (P = 0.001) was an independent prognostic factor.ConclusionsThe NLR/Alb is a novel and usefull predictive factor in patients with ESCC.

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Chemoradiotherapy in the Management of Locally Advanced Squamous Cell Carcinoma Esophagus: Is Surgical Resection Required?

Abstract: The study suggests that there is no difference in clinical toxicity profiles or survival outcomes with either definitive chemoradiotherapy or chemoradiation followed by surgery in management of locally advanced esophageal cancer.

Cited by 23 publications

References 37 publications

Lymphopenia Predicts Poor Prognosis in Patients With Esophageal Squamous Cell Carcinoma

Lymphopenia Predicts Poor Prognosis in Patients With Esophageal Squamous Cell Carcinoma

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

A novel inflammation-based prognostic index for patients with esophageal squamous cell carcinoma: neutrophil lymphocyte ratio/albumin ratio

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