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01-07-2012 | Gastrointestinal Oncology

Comparison Between Radical Esophagectomy and Definitive Chemoradiotherapy in Patients with Clinical T1bN0M0 Esophageal Cancer

Authors: Masaaki Motoori, MD, Masahiko Yano, MD, Ryu Ishihara, MD, Sachiko Yamamoto, MD, Yoshifumi Kawaguchi, MD, Koji Tanaka, MD, Kentaro Kishi, MD, Isao Miyashiro, MD, Yoshiyuki Fujiwara, MD, Tatsushi Shingai, MD, Shingo Noura, MD, Masayuki Ohue, MD, Hiroaki Ohigashi, MD, Satoaki Nakamura, MD, Osamu Ishikawa, MD

Published in: Annals of Surgical Oncology | Issue 7/2012

Abstract

Background

Esophagectomy remains the mainstay treatment for clinical T1bN0M0 esophageal cancer because pathologic lymph node metastases in these patients are not negligible. Recently, chemoradiotherapy (CRT), which can preserve the esophagus, has been reported to be a promising therapeutic alternative to esophagectomy. However, to our knowledge, no comparative studies of esophagectomy and CRT have been reported in clinical T1bN0M0 esophageal cancer.

Methods

A total of 173 patients with clinical T1bN0M0 squamous cell carcinoma of the thoracic esophagus were enrolled in this study, 102 of whom were treated with radical esophagectomy (S group) and 71 with definitive CRT (CRT group). Treatment results of both groups were retrospectively compared.

Results

No statistically significant difference was found in overall survival, but the S group displayed significantly better progression-free survival than the CRT group. Disease recurrence was observed in 12 S group patients and 20 CRT group patients. The incidence of distant recurrence was similar, while local recurrence and lymph node recurrence were significantly more frequent in the CRT group. In the S group, 20 patients had pathologic lymph node metastasis. The progression-free survival of patients with pathologic lymph node metastasis did not differ from those without nodal metastasis. In the CRT group, local recurrence could be controlled by salvage esophagectomy, but treatment results of lymph node recurrence were poor; only 4 of 12 patients with lymph node recurrences were cured.

Conclusions

Selection of patients at high risk of pathologic lymph node metastasis is essential when formulating treatment decisions for clinical T1bN0M0 esophageal cancers.

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Title: Comparison Between Radical Esophagectomy and Definitive Chemoradiotherapy in Patients with Clinical T1bN0M0 Esophageal Cancer
Authors: Masaaki Motoori, MD
Masahiko Yano, MD
Ryu Ishihara, MD
Sachiko Yamamoto, MD
Yoshifumi Kawaguchi, MD
Koji Tanaka, MD
Kentaro Kishi, MD
Isao Miyashiro, MD
Yoshiyuki Fujiwara, MD
Tatsushi Shingai, MD
Shingo Noura, MD
Masayuki Ohue, MD
Hiroaki Ohigashi, MD
Satoaki Nakamura, MD
Osamu Ishikawa, MD
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 7/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2231-8

At a glance: The STEP trials

Springer Medicine

Comparison Between Radical Esophagectomy and Definitive Chemoradiotherapy in Patients with Clinical T1bN0M0 Esophageal Cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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