Optimal Treatment of cT2N0 Esophageal Carcinoma: Is Upfront Surgery Really the Way?

Capovilla, Giovanni; Moletta, Lucia; Pierobon, Elisa Sefora; Salvador, Renato; Provenzano, Luca; Zanchettin, Gianpietro; Costantini, Mario; Merigliano, Stefano; Valmasoni, Michele

doi:10.1245/s10434-021-10194-9

Cited by 2 publications

(3 citation statements)

References 32 publications

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“…Pathologic N-negativity was even more present in both neoadjuvant treated groups despite limited histopathological response. This finding is in line with other studies and indicates that cN-stage staging cannot be relied upon for treatment decisions 26 , 27 .…”

Section: Discussionsupporting

confidence: 92%

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Age-dependent benefit of neoadjuvant treatment in adenocarcinoma of the esophagus and gastroesophageal junction: a multicenter retrospective observational study of young versus old patients

Rompen,

Crnovrsanin,

Nienhüser

et al. 2023

International Journal of Surgery

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Objectives: To provide evidence for age-dependent use of neoadjuvant treatment by clinical comparisons of young (lower quartile, <56.6 y) versus old (upper quartile, >71.3 y) esophageal and esophagogastric-junction adenocarcinoma (EAC) patients. Background: Neoadjuvant treatment is the standard of care for locally advanced and node-positive EAC. However, the effect of age on oncological outcomes is disputable as they are underrepresented in treatment defining randomized controlled trials. Methods: Patients with EAC undergoing esophagectomy between 2001 and 2022 were retrospectively analyzed from three centers. Patients having distant metastases or clinical UICC-Stage I were excluded. Cox proportional hazards regression was used to identify the variables associated with survival benefit. Results: Neoadjuvant treatment was administered to 185/248 (74.2%) young and 151 out of 248 (60.9%) elderly patients (P=0.001). Young age was associated with a significant overall survival (OS) benefit (median-OS: 85.6 vs. 29.9 mo, HR0.62, 95%CI:0.42-0.92) after neoadjuvant treatment versus surgery alone. In contrast, elderly patients did only experience a survival benefit equaling the length of neoadjuvant treatment itself (median-OS: neoadjuvant 32.8 vs. surgery alone 29.3 mo, HR0.89, 95%CI:0.63-1.27). Despite the clear difference in median OS benefit, histopathological regression (Mandard-TRG 1/2) was similar (young 30.7% vs. old 36.4%, P=0.286). More elderly patients had dose reduction or termination of neoadjuvant treatment (12.4% vs. 40.4%, P<0.001). Conclusion: Old patients benefit less from neoadjuvant treatment compared to younger patients in terms of gain in overall survival. Since they also experience more side effects requiring dose reduction, upfront surgery should be considered as the primary treatment option in elderly patients.

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Section: Discussionsupporting

confidence: 92%

“…This finding can be explained by imprecise clinical staging. Sixty percent of the cT2 and clinically staged nodal-negative disease show nodal-positive disease in the histopathologic workup despite neoadjuvant treatment 26 , 27 . Furthermore, there is a difference of about 30% in cN-negative to pN-negative in the surgery alone groups.…”

Section: Discussionmentioning

confidence: 99%

Age-dependent benefit of neoadjuvant treatment in adenocarcinoma of the esophagus and gastroesophageal junction: a multicenter retrospective observational study of young versus old patients

Rompen,

Crnovrsanin,

Nienhüser

et al. 2023

International Journal of Surgery

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“…For this reason, many patients staged with T2N0 cancers are now undergoing preoperative chemoradiation. This practice is supported by Capovilla et al [ 11 ], whose study demonstrated that patients with T2N0 esophageal and squamous cell cancers who underwent neoadjuvant therapy had a statistically higher survival rate than patients who underwent up front surgery. If future studies support this practice, then the importance/ role of EUS in triaging patients to neoadjuvant vs surgery may in fact diminish[ 7 - 11 ].…”

Section: Eus and Stagingmentioning

confidence: 79%

Role of endoscopic ultrasound in esophageal cancer

Radlinski¹,

Shami²

2022

WJGE

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Esophageal cancer (ECA) affects 1 in 125 men and 1 in 417 for women and accounts for 2.6% of all cancer related deaths in the United States. The associated survival rate depends on the stage of the cancer at the time of diagnosis, making adequate work up and staging imperative. The 5-year survival rate for localized disease is 46.4%, regional disease is 25.6%, and distant/metastatic disease is 5.2%. Additionally, treatment is stage-dependent, making staging all that much important. For nonmetastatic transmural tumors (T3) and/or those that have locoregional lymph node involvement (N), neoadjuvant therapy is recommended. Conversely, for those who have earlier tumors, upfront surgical resection is reasonable. While positron emission tomography/computed tomography and other cross sectional imaging modalities are exceptional for detecting distant disease, they are inaccurate in staging locoregional disease. Endoscopic ultrasound (EUS) has played a key role in the locoregional (T and N) staging of newly diagnosed ECA and has an evolving role in restaging after neoadjuvant therapy. There is even data to support that the use of EUS facilitates proper triaging of patients and may ultimately save money by avoiding unnecessary or futile treatment. This manuscript will review the current role of EUS on staging and restaging of ECA.

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Optimal Treatment of cT2N0 Esophageal Carcinoma: Is Upfront Surgery Really the Way?

Cited by 2 publications

References 32 publications

Age-dependent benefit of neoadjuvant treatment in adenocarcinoma of the esophagus and gastroesophageal junction: a multicenter retrospective observational study of young versus old patients

Age-dependent benefit of neoadjuvant treatment in adenocarcinoma of the esophagus and gastroesophageal junction: a multicenter retrospective observational study of young versus old patients

Role of endoscopic ultrasound in esophageal cancer

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