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01-09-2020 | Esophageal Cancer | Gastrointestinal Oncology

Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma

Authors: Eisuke Booka, MD, PhD, Ryoma Haneda, MD, Kenjiro Ishii, MD, PhD, Takeshi Kawakami, MD, Takahiro Tsushima, MD, Hirofumi Yasui, MD, Tsuyoshi Onoe, MD, Hirofumi Ogawa, MD, Yasuhiro Tsubosa, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2020

Abstract

Background

Standard treatment for unresectable locally advanced esophageal cancer is definitive chemoradiotherapy (dCRT). Although salvage esophagectomy is the only curative treatment available following dCRT failure, the appropriate candidates for salvage esophagectomy remain unclear.

Patients and Methods

Three hundred seventeen patients who underwent dCRT from April 2004 to December 2016 were stratified into three study groups—a complete response (CR) group, chemotherapy or best supportive care (BSC) group, and salvage esophagectomy group—and compared. We also investigated the clinical outcomes and prognostic factors of salvage esophagectomy.

Results

Seventy-one patients (22.4%) achieved CR after dCRT, 18 patients (5.7%) underwent salvage esophagectomy, and 228 patients (71.9%) underwent palliative chemotherapy or BSC. The 5-year overall survival (OS) rates of the CR group, salvage esophagectomy group, and chemotherapy or BSC group were 83.0%, 51.6%, and 1.3%, respectively. Salvage esophagectomy recipients had a worse OS rate than CR patients (p < 0.001) but a better OS rate than those in the chemotherapy or BSC group (p < 0.001). Incomplete resection was the only significant variable associated with poor OS on univariate Cox proportional-hazards analysis (hazard ratio: 7.633, 95% confidence interval: 1.692–34.482; p = 0.008). Patients with tumors in the upper thoracic esophagus were more likely to undergo incomplete resection (p = 0.011).

Conclusions

Patients who achieve R0 resection are good candidates for salvage esophagectomy regardless of their response to dCRT. Those with upper thoracic esophageal tumors are at risk of incomplete resection; careful attention is required when considering these patients for salvage esophagectomy.

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Title: Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma
Authors: Eisuke Booka, MD, PhD
Ryoma Haneda, MD
Kenjiro Ishii, MD, PhD
Takeshi Kawakami, MD
Takahiro Tsushima, MD
Hirofumi Yasui, MD
Tsuyoshi Onoe, MD
Hirofumi Ogawa, MD
Yasuhiro Tsubosa, MD, PhD
Publication date: 01-09-2020
Publisher: Springer International Publishing
Keywords: Esophageal Cancer
Esophagus Resection
Esophageal Cancer
Esophagus Resection
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 9/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-020-08440-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma

Abstract

Background

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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