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World Journal of Surgery

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01-09-2013

Induction Chemotherapy or Chemoradiotherapy Followed by Radical Esophagectomy for T4 Esophageal Cancer: Results of a Prospective Cohort Study

Authors: Hideaki Shimoji, Hiroyuki Karimata, Masayoshi Nagahama, Tadashi Nishimaki

Published in: World Journal of Surgery | Issue 9/2013

Abstract

Background

We hypothesized that the survival rate of patients undergoing R0 esophagectomy after induction chemotherapy or chemoradiotherapy for unresectable T4 esophageal cancer (URT4) would be similar to that of patients undergoing esophagectomy for immediately resectable esophageal cancer with no unfavorable prognostic factors (RNU).

Methods

Between April 2002 and June 2012, 87 of 283 patients with esophageal cancer who presented at the University Hospital of the Ryukyus were enrolled in this prospective cohort study. Tumors were classified as RNU and URT4 in 44 and 43 of the 87 patients, respectively. Outcomes of treatment for URT4 patients were compared with those of RNU patients.

Results

The R0 resection rate (61 %) and in-hospital mortality rate (20 %) of URT4 patients were significantly poorer than those of RNU patients (98 and 2.3 %, respectively), although the morbidity rate was similar in the two groups (63 and 52 %, respectively). The 5-year survival rate (35 %) of URT4 patients was significantly poorer than that of RNU patients (67 %) in the intention-to-treat analysis. However, no significant difference was noted between the two survival curves for cases of R0 resection (5-year survival rate, 60 % vs. 69 %). Multivariate analysis revealed R status as the only significant independent prognostic factor for URT4 patients (P < 0.001; hazard ratio = 8.279).

Conclusions

Satisfactory survival rates can be achieved if R0 resection is performed after induction treatment in patients with T4 esophageal cancer, although secondary radical esophagectomy is associated with a higher risk of in-hospital mortality.

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Title: Induction Chemotherapy or Chemoradiotherapy Followed by Radical Esophagectomy for T4 Esophageal Cancer: Results of a Prospective Cohort Study
Authors: Hideaki Shimoji
Hiroyuki Karimata
Masayoshi Nagahama
Tadashi Nishimaki
Publication date: 01-09-2013
Publisher: Springer US
Published in: World Journal of Surgery / Issue 9/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-2074-x

At a glance: The STEP trials

Springer Medicine

Induction Chemotherapy or Chemoradiotherapy Followed by Radical Esophagectomy for T4 Esophageal Cancer: Results of a Prospective Cohort Study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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