Neoadjuvant chemoradiotherapy followed by esophagectomy versus definitive chemoradiotherapy in resectable stage II/III (T1-3N0, 1M0) esophageal squamous cell carcinoma

Abstract

Background. There are two intensive modalities for the treatment of resectable esophageal carcinoma: esophagectomy and definitive chemoradiotherapy (CRT). Esophagectomy with preoperative CRT was retrospectively compared with CRT alone in resectable stage II/III esophageal squamous cell carcinoma. Methods. Seventy-four patients with resectable stage II/III (T1-3N0, 1M0) esophageal squamous cell carcinoma were treated with preoperative CRT by 5-fluorouracil (5-FU) 700 mg/m 2 on days 1 to 5, nedaplatin 80 mg/m 2 on day 1, and concurrent radiation for a total of 30 Gy in 3 weeks. If patients decided to undergo surgery, esophagectomy from the thoracoabdominal approach was carried out 6 weeks after the completion of CRT (CRT + Surg group, n = 51). If patients decided not to undergo surgery, they were treated with one more course of CRT (CRT-alone group, n = 23). Results. There was no significant difference in overall survival between the two groups (P = 0.1006), whereas the disease-free survival in the CRT + Surg group was improved compared with the CRT-alone group (P = 0.0186). In the patients with clinical stage III carcinoma or with regional lymph node metastasis, the overall survival rate was significantly improved in the CRT + Surg group compared with the CRT-alone group. The rate of local failures in the CRT + Surg group was significantly lower compared with the CRT-alone group (P = 0.0011). Conclusions. Preoperative CRT followed by esophagectomy provides better local control, but does not prolong overall survival, compared with definitive CRT. However, in clinical stage III or N1, esophagectomy with preoperative CRT could contribute to the improvement of survival in esophageal squamous cell carcinoma.

Definitive Chemoradiotherapy Versus Trimodality Therapy for Resectable Oesophageal Carcinoma: Meta‐analyses and Systematic Review of Literature

“…The inclusion criteria were met by 35 articles describing 32 studies (21 Western and 11 Asian; Fig. 1) [7, 13, 14, 17–48]. Of the 35 articles included, two were RCTs and 33 were observational.…”

Therapy‐related leukemia following chemoradiotherapy for esophageal cancer

“…From July 2000 to March 2008, 348 patients (316 male and 32 female patients) with esophageal cancer underwent CRT in Chiba Cancer Center Hospital as described before (10). All patients were histologically diagnosed with squamous cell carcinoma.…”

Faculty Opinions recommendation of Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1.

“…With regard to observational studies, 10 papers of studies comparing surgery and definitive chemoradiotherapy in patients with cStage II or III esophageal cancer, including 6 papers from Japan, were retrieved [36][37][38][39][40][41][42][43][44]. None of the studies was a randomized comparative study; therefore, many of the studies differed in terms of the background factors of the patients and in the therapeutic regimens adopted from those currently adopted in Japan.…”