Top

Published in:

01-11-2014

Is the Outcome of a Salvage Surgery for T4 Thoracic Esophageal Squamous Cell Carcinoma Really Poor?

Authors: Yasunori Akutsu, Tsuguaki Kono, Masaya Uesato, Isamu Hoshino, Kentaro Murakami, Tomoyoshi Aoyagi, Takumi Ota, Takeshi Toyozumi, Hiroshi Suito, Hiroki Kobayashi, Rintaro Harada, Takashi Uno, Hisahiro Matsubara

Published in: World Journal of Surgery | Issue 11/2014

Abstract

Background

Among patients with T4 thoracic esophageal squamous cell carcinoma (TESCC), it is unclear whether the outcomes of late responders who undergo high-dose chemoradiotherapy (CRT) followed by salvage esophagectomy differs from those of early responders who undergo low-dose CRT followed by esophagectomy.

Methods

A total of 153 patients with T4 TESCC were treated with CRT. The first evaluation was performed after 40 Gy of CRT for downstaging. Of these, 28 patients could be downstaged, and underwent subsequent surgery (early responders). For the remaining patients, additional CRT was administered, and patients were re-evaluated after treatment and underwent salvage surgery. In total, 40 patients (early + late responders) were analyzed.

Results

The primary tumors exhibited a grade 3 response in six (21.4 %) of the early responders and two (16.7 %) of the late responders (p = 1.000). The rate of residual tumor in the primary tumor was 80 % (32/40 patients). The proportions of resected lymph nodes and positive metastatic nodes were similar between early and late responders (p = 0.406 and p = 0.859, respectively). The 5-year overall survival rates among the early and late responders were 25.9 and 36.5 %, respectively, and the median survival times were 24.8 and 24.3 months (p = 0.925), respectively. The 5-year cause-specific survival rates in the early and late responder groups were 61.5 and 72.9 % (p = 0.425), respectively.

Conclusion

The outcomes of both early and late responders to CRT were similar, and salvage surgery for T4 TESCC outweighs the risks in patients with T4 TESCC.

Ozawa S, Tachimori Y, Baba H et al (2012) Comprehensive registry of esophageal cancer in Japan, 2004. Esophagus 9:75–98CrossRef

Akutsu Y, Uesato M, Shuto K et al (2013) The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 Patients. Ann Surg 257(6):102–108CrossRef

Griffin SM, Burt AD, Jennings NA (2011) Lymph node metastasis in early esophageal adenocarcinoma. Ann Surg 254:731–736 discussion 736–737PubMedCrossRef

Shimada H, Shiratori T, Okazumi S et al (2008) Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45 years of experience. J Am Coll Surg 206:48–56PubMedCrossRef

Nabeya Y, Ochiai T, Matsubara H et al (2005) Neoadjuvant chemoradiotherapy followed by esophagectomy for initially resectable squamous cell carcinoma of the esophagus with multiple lymph node metastasis. Dis Esophagus 18(6):388–397PubMedCrossRef

Miyoshi N, Yano M, Takachi K et al (2009) Myelotoxicity of preoperative chemoradiotherapy is a significant determinant of poor prognosis in patients with T4 esophageal cancer. J Surg Oncol 99:302–306PubMedCrossRef

de Manzoni G, Pedrazzani C, Pasini F et al (2007) Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol 95:261–266PubMedCrossRef

Seto Y, Chin K, Gomi K et al (2007) Treatment of thoracic esophageal carcinoma invading adjacent structures. Cancer Sci 98:937–942PubMedCrossRef

Akutsu Y, Matsubara H, Shuto K et al (2009) Clinical and pathologic evaluation of the effectiveness of neoadjuvant chemoradiation therapy in advanced esophageal cancer patients. World J Surg 33:1002–1009. doi:10.1007/s00268-008-9899-8 PubMedCrossRef

10.

Shimoji H, Karimata H, Nagahama M et al (2013) Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: results of a prospective cohort study. World J Surg 37(9):2180–2188. doi:10.1007/s00268-013-2074-x PubMedCrossRef

11.

Tachibana M, Dhar DK, Kinugasa S et al (2002) Surgical treatment for locally advanced (T4) squamous cell carcinoma of the thoracic esophagus. Dysphagia 17:255–261PubMedCrossRef

12.

Miyata H, Yamasaki M, Takiguchi S et al (2009) Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol 100:442–446PubMedCrossRef

13.

Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174PubMedCrossRef

14.

Cooper JS, Guo MD, Herskovic A et al (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 281:1623–1627PubMedCrossRef

15.

Aoyagi T, Shuto K, Okazumi S et al (2010) Evaluation of the clinical staging of esophageal cancer by using diffusion-weighted imaging. Exp Ther Med 1:847–851

16.

Takubo K, Makuuchi H, Fujita H et al (2009) Japanese classification of esophageal cancer, tenth edition: part I. Esophagus 6:1–25CrossRef

17.

Takubo K, Makuuchi H, Fujita H et al (2009) Japanese classification of esophageal cancer, tenth edition: parts II and III. Esophagus 6:71–94CrossRef

18.

Markar SR, Karthikesalingam A, Penna M et al (2014) Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol 21(3):922–931PubMedCrossRef

19.

Murphy CC, Correa AM, Ajani JA et al (2013) Surgery is an essential component of multimodality therapy for patients with locally advanced esophageal adenocarcinoma. J Gastrointest Surg 17(8):1359–1369PubMedCrossRef

20.

Piessen G, Messager M, Mirabel X et al (2013) Is there a role for surgery for patients with a complete clinical response after chemoradiation for esophageal cancer? An intention-to-treat case-control study. Ann Surg 258:793–800PubMedCrossRef

21.

Makino T, Doki Y (2011) Treatment of T4 esophageal cancer. Definitive chemo-radiotherapy vs chemo-radiotherapy followed by surgery. Ann Thorac Cardiovasc Surg 17(3):221–228PubMedCrossRef

22.

Fujita H, Sueyoshi S, Tanaka T et al (2005) Esophagectomy: is it necessary after chemoradiotherapy for a locally advanced T4 esophageal cancer? Prospective nonrandomized trial comparing chemoradiotherapy with surgery versus without surgery. World J Surg 29:25–30. doi:10.1007/s00268-004-7590-2 discussion 30–31PubMedCrossRef

23.

Welsh J, Settle SH, Amini A et al (2012) Failure patterns in patients with esophageal cancer treated with definitive chemoradiation. Cancer 118:2632–2640PubMedCrossRefPubMedCentral

24.

Shimada H, Okazumi S, Matsubara H et al (2006) Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection. World J Surg 30:1441–1449. doi:10.1007/s00268-005-0462-6 PubMedCrossRef

25.

Akutsu Y, Shuto K, Kono T et al (2012) The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma. J Surg Oncol 105:756–760PubMedCrossRef

26.

Akutsu Y, Matsubara H (2013) Lymph node dissection for esophageal cancer. Gen Thorac Cardiovasc Surg 61(7):397–401PubMedCrossRef

27.

Crosby TD, Brewster AE, Borley A et al (2004) Definitive chemoradiation in patients with inoperable oesophageal carcinoma. Br J Cancer 90:70–75PubMedCrossRefPubMedCentral

Title: Is the Outcome of a Salvage Surgery for T4 Thoracic Esophageal Squamous Cell Carcinoma Really Poor?
Authors: Yasunori Akutsu
Tsuguaki Kono
Masaya Uesato
Isamu Hoshino
Kentaro Murakami
Tomoyoshi Aoyagi
Takumi Ota
Takeshi Toyozumi
Hiroshi Suito
Hiroki Kobayashi
Rintaro Harada
Takashi Uno
Hisahiro Matsubara
Publication date: 01-11-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 11/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2668-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Is the Outcome of a Salvage Surgery for T4 Thoracic Esophageal Squamous Cell Carcinoma Really Poor?

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2014

Assessment of Motor Function of the Remnant Stomach by 13C Breath Test With Special Reference to Gastric Local Resection

Sensitivity and Specificity of Red Cell Distribution Width in Diagnosing Acute Mesenteric Ischemia in Patients with Abdominal Pain

Preoperative Biliary Drainage of Severely Jaundiced Patients Increases Morbidity of Pancreaticoduodenectomy: Results of a Case-Control Study

Quality of Life After Surgical Treatment of Early Barrett’s Cancer: A Prospective Comparison of the Ivor–Lewis Resection Versus the Modified Merendino Resection. A Statistical Hint: Reply

The Quality of Life after Surgery for HCC can support the Choice of this Treatment

Quality of Life after Surgical Treatment of Early Barrett’s Cancer: A Prospective Comparison of the Ivor–Lewis Resection Versus the Modified Merendino Resection. A Statistical Hint