Utility of preoperative chemoradiotherapy for advanced esophageal carcinoma

Abstract

Background and Aims: The most effective treatment would be neoadjuvant chemoradiotherapy (NACRT) plus surgery with three-field lymphadenectomy, if tolerability and complications are acceptable. The aim of this prospective study was to evaluate the tolerability of NACRT+ systematic three-field lymphadenectomy. Methods: A total of 127 cases of advanced esophageal carcinoma were objected, among which 32 had NACRT, being the cases suspected to cT3-T4 or, < cT3 with multiple lymph node metastasis. м T2 of 95 cases were treated by surgery alone (NACRT [-] case). The effect of NACRT was evaluated by histological examination and corrected with the clinicopathologic factors, including postoperative prognosis. After reports JCOG9907, we treated eight cases with neoadjuvant chemotherapy at stages II and III. We examined Musashi-1 staining for these eight cases. Results: Histological good response to NACRT group showed good prognosis. Lymph node metastasis is a predictive factor for prognosis. In this additional study, Musashi-1 was positive after neoadjuvant chemotherapy in three cases. The histological response was grade 1 in all of them and recurrence was observed within a short period of time. Two cases of grade 3 were negative staining to Musashi-1 and showed no recurrence. Conclusions: This study shows that NACRT plus surgery with three-field lymphadenectomy is a feasible therapeutic approach for the cases with multiple lymph node metastases. Prognosis was significantly better in cases with marked histological improvement. It is important to find the predictive factors of histological improvement. Musashi-1 might be a candidate maker for histological response and prognosis, and further studies are needed to prove it.

Pathologic Complete Response (Ypt0 Ypn0) After Chemotherapy and Radiotherapy Neoadjuvant Followed by Esophagectomy in the Squamous Cell Carcinoma of the Esophagus

“…The neoadjuvant therapy as a therapeutic strategy in esophageal squamous cell carcinoma has been used for many years 19 , 20 . This neoadjuvance may be only preoperative radiotherapy in the tumor area or, more recently, the use of associated radiotherapy and chemotherapy, thus affecting the tumor area and possible metastases 15 , 43 .…”

“…Several recent publications assess the role of neoadjuvant therapy in squamous cell carcinoma 2 , 17 , 20 , 36 , 39 , 44 , 47 , regarding the disease-free interval and survival. The PET-CT has been suggested as a method for this assessment, still with inconclusive results 2 , 17 , 20 , 36 , 39 , 44 , 47 . However, doubts on the benefits for global survival of patients still persist 14 , 35 , 45 .…”

Neoadjuvant chemotherapy with or without neoadjuvant radiotherapy compared with neoadjuvant chemoradiotherapy for esophageal cancer

“…More evidence available is supporting the use of NACR worldwide, especially for locally advanced disease (4). Even in Japan, NACR is recommended in patients whose disease is suspected to be borderline resectable (5). However, the side effects of NACR cannot be ignored.…”