Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by surgery for stage II to III esophageal squamous cell carcinoma

Barbetta, Arianna; Hsu, Meier; Tan, Kay See; Stefanova, Dessislava; Herman, Koby; Adusumilli, Prasad S.; Bains, Manjit S.; Bott, Matthew; Isbell, James M.; Janjigian, Yelena Y.; Ku, Geoffrey Yuyat; Park, Bernard J.; Wu, Abraham J.; Jones, David R.; Molena, Daniela

doi:10.1016/j.jtcvs.2018.01.086

Cited by 44 publications

(37 citation statements)

References 33 publications

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“…After a median follow-up of 20.4 months, no significant differences were visible for median OS (25.9 months vs. 20.6 months) and PFS (14.9 months vs. 15.6 months). In contrast to that, Barbetta and colleagues [8] reported an improved OS (median OS 2.3 years vs. 3.1 years) and DFS (median DFS 1 year vs. 1.8 years) after nCRT + S. The most obvious difference to the present study is the exclusion of patients with cervical or upper thoracic tumors. In our study, a more proximal tumor location was associated with shorter OS and PFS within multivariate Cox regression analysis.…”

Section: Discussioncontrasting

confidence: 92%

“…While our absolute data for OS and PFS are comparable with two other recent studies [7, 8], there are conflicting results in terms of the relative difference between patients treated with nCRT + S and patients treated with dCRT. Haefner and colleagues [7] compared dCRT with nCRT + S in patients with esophageal cancer.…”

Section: Discussionsupporting

confidence: 68%

“…After a median follow-up time of 20.4 months, no significant differences were seen regarding progression-free survival (PFS) and OS between both treatment regimes. In contrast, a recent retrospective cohort study by Barbetta et al [8] demonstrated an improved OS and DFS after nCRT + S compared to dCRT in patients with thoracic or distal E-SCC. In addition, further retrospective trials also demonstrated an increased survival after nCRT + S in EC patients [9–11].…”

Section: Introductionmentioning

confidence: 83%

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Neoadjuvant versus definitive chemoradiation in patients with squamous cell carcinoma of the esophagus

et al. 2019

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Background Multimodal treatment with neoadjuvant chemoradiation followed by surgery (nCRT + S) is the treatment of choice for patients with locally advanced or node-positive esophageal squamous cell carcinoma (E-SCC). Those who are unsuitable or who decline surgery can be treated with definitive chemoradiation (dCRT). This study compares the oncologic outcome of nCRT + S and dCRT in E-SCC patients. Methods Between 2011 and 2017, 95 patients with E-SCC were scheduled for dCRT or nCRT+ S with IMRT at our department. Patients undergoing dCRT received at least 50 Gy and those undergoing nCRT + S received at least 41.4 Gy. All patients received simultaneous chemotherapy with either carboplatin and paclitaxel or cisplatin and 5-fluoruracil. We retrospectively compared baseline characteristics and oncologic outcome including overall survival (OS), progression-free survival (PFS) and site of failure between both treatment groups. Results Patients undergoing dCRT were less likely to have clinically suspected lymph node metastases (85% vs. 100%, p = 0.019) than patients undergoing nCRT + S and had more proximally located tumors (median distance from dental arch to cranial tumor border 20 cm vs. 26 cm, p < 0.001). After a median follow up of 25.6 months for surviving patients, no significant differences for OS and PFS were noticed comparing nCRT + S and dCRT. However, the rate of local tumor recurrence was significantly higher in patients treated with dCRT than in those treated with nCRT + S (38% vs. 10%, p = 0.002). Within a multivariate Cox regression model, age, tumor location, and tumor grading were the only independent parameters affecting OS and PFS. In addition to that, proximal tumor location was the only parameter independently associated with an increased risk for local treatment failure. Conclusion In E-SCC patients treated with either dCRT or nCRT + S, a higher rate of local tumor recurrence was seen in patients treated with dCRT than in patients treated with nCRT + S. There was at least a trend towards an improved OS and PFS in patients undergoing nCRT + S. However, this should be interpreted with caution, because proximal tumor location was the only parameter independently affecting the risk of local tumor recurrence.

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Section: Discussioncontrasting

confidence: 92%

Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 83%

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Neoadjuvant versus definitive chemoradiation in patients with squamous cell carcinoma of the esophagus

et al. 2019

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“…Traditionally, surgery is considered as the primary treatment for resectable esophageal cancer patients, but the surgical outcomes for the locally advanced disease seems hard to improve. Since previous studies have demonstrated the positive role of neoadjuvant therapy on the prognosis of esophageal cancer patients [3,6,15], the use of preoperative therapy followed by surgery has become common practice for the locally advanced ESCC patients in the clinical application. Neoadjuvant CT and CRT contribute to the clearance of micrometastatic disease and tumor down staging, which bene ts a more radical surgical resection and a better survival.…”

Section: Discussionmentioning

confidence: 99%

Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

Chen

Wang

et al. 2020

Preprint

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Background Although previous studies have discussed whether the minimally invasive esophagectomy (MIE) is superior to open surgery, the data concerning esophageal squamous cell carcinoma (ESCC) patients underwent neoadjuvant treatment followed by radical resection is limited. The purpose of our study was to compare the short- and long-term clinical outcomes of the two surgical approaches in treating ESCC patients.MethodsBetween January 2010 and December 2016, ESCC patients who had received neoadjuvant therapy and underwent Mckeown esophagectomy at our institute were eligible. The baseline characteristics, pathological data, short-and long-term outcomes of these patients were collected and compared based on the surgical approach. ResultsA total of 195 patients was included in the current study. Compared to patients underwent open surgery, patients underwent MIE had shorter operative time and less intraoperative bleeding (390 min vs 330 min, P=0.001; 204 ml vs 167 ml, P=0.021). In addition, the risk of anastomotic leakage was decreased in MIE group (20.0% vs 3.3%, P<0.001), while the occurrence of other complications did not have statistical significance between two groups. Overall survival (OS) and disease-free survival (DFS) was no difference in patients received neoadjuvant chemotherapy between the two approaches. For the patients underwent neoadjuvant chemoradiotherapy, OS was significantly better in the MIE group (log rank=6.197; P=0.013). ConclusionMinimally invasive Mckeown esophagectomy is safe and feasible for ESCC patients who underwent neoadjuvant therapy. MIE approach presented better perioperative results than open esophagectomy. The effect of surgical approaches on survival was depending on the scheme of neoadjuvant treatment.

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“…Surgery remains the fundamental modality for patients with operable EC. Nowadays, neoadjuvant therapy, especially neoadjuvant chemoradiotherapy (nCRT), followed by surgery has been confirmed as a preferential treatment strategy for patients with locally advanced EC, which is associated with favorable long-term survival [2] , [3] , [4] , [5] , [6] .…”

Section: Introductionmentioning

confidence: 99%

Does the lymph node yield affect survival in patients with esophageal cancer receiving neoadjuvant therapy plus esophagectomy? A systematic review and updated meta-analysis

et al. 2020

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Background Conflicting data have been reported on the prognostic impact of the extent of lymphadenectomy during esophagectomy for esophageal cancer (EC) after neoadjuvant therapy, especially after neoadjuvant chemoradiotherapy (nCRT). Methods A comprehensive online search was performed to explore the association between increased lymph node yield (LNY) and survival of patients with EC, in which the overall survival (OS) was set as the primary outcome. In addition to analysis of the entire cohort, subgroup analyses of different induction therapy and different populations were also performed. Findings A total of 19528 patients from twelve studies were included in our study. The pooled data revealed that more lymph node harvested was associated with better OS (HR = 0·87; 95% CI: 0·79–0·95, p < 0·001). Notably, a higher LNY was associated with better OS if the threshold was less than 18. However, more thorough lymphadenectomy might not bring additional survival benefits when it came to a cutoff value more than 18. The subgroup analysis further revealed that a higher LNY after nCRT was associated favorable survival. In terms of subset analysis of different populations, increased LNY was associated with longer OS in Western populations but not in Eastern. Interpretation Increased LNY during esophagectomy after neoadjuvant therapy, especially after nCRT, might be associated with improved OS. More studies are warranted to assess the survival benefits of a higher LNY receiving neoadjuvant therapy plus esophagectomy, especially in Eastern populations. Funding Supported by the projects from Suzhou Key Laboratory of Thoracic Oncology (SZS201907), Suzhou Key Discipline for Medicine (SZXK201803), the Science and Technology Research Foundation of Suzhou Municipality (SYS2018063, SYS2018064), Municipal Program of People's Livelihood Science and Technology in Suzhou (SS2019061) and Major Project for Social Development, Jiangsu Provincial Department of Science and Technology (SBE2020750085).

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Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by surgery for stage II to III esophageal squamous cell carcinoma

Cited by 44 publications

References 33 publications

Neoadjuvant versus definitive chemoradiation in patients with squamous cell carcinoma of the esophagus

Neoadjuvant versus definitive chemoradiation in patients with squamous cell carcinoma of the esophagus

Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments

Does the lymph node yield affect survival in patients with esophageal cancer receiving neoadjuvant therapy plus esophagectomy? A systematic review and updated meta-analysis

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