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01-06-2021 | Esophagus Resection | Original Scientific Report

Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma

Authors: Ryoma Haneda, Eisuke Booka, Kenjiro Ishii, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Kinji Kamiya, Hirofumi Ogawa, Hirofumi Yasui, Hiroya Takeuchi, Yasuhiro Tsubosa

Published in: World Journal of Surgery | Issue 6/2021

Abstract

Background

The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and recently, good clinical outcomes of this treatment have been reported. This study compared prognosis after definitive chemoradiotherapy with radical esophagectomy.

Methods

From January 2011 to December 2019, 68 consecutive patients who were diagnosed clinical T1bN0M0 squamous cell carcinoma were enrolled and investigated retrospectively. Patients were classified into two groups whether treated by surgery or definitive chemoradiotherapy. Survival outcomes were compared, and subsequent therapies after recurrence were also investigated.

Results

Among 68 patients, 39 patients underwent surgery and 29 patients received definitive chemoradiotherapy. No significant difference was noted in overall survival between the two groups. However, the rate of 5-year recurrence-free survival was significantly lower in definitive chemoradiotherapy group than that of surgery group (91.1 vs. 62.7%, hazard ratio 3.976, 95% confidence interval 1.076–14.696, p = 0.039). Patients who had local recurrence after definitive chemoradiotherapy received endoscopic submucosal dissection or photodynamic therapy as salvage therapies, which resulted in no disease progression and a good prognosis.

Conclusions

Definitive chemoradiotherapy may become a promising alternative therapy comparable with radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma. Early detection of recurrence by frequent follow-up after definitive chemoradiotherapy is important to control disease within local recurrence, and salvage therapy for local lesions could contribute to long-term survival.

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Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRef

Matsuda S, Takeuchi H, Kawakubo H et al (2016) Current advancement in multidisciplinary treatment for resectable cStage II/III esophageal squamous cell carcinoma in Japan. Ann Thorac Cariovasc Surg 22:275–283CrossRef

Shapiro J, van Lanschot JJB, Hulshof MCCM et al (2015) Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 16:1090–1098CrossRef

Ando N, Ozawa S, Kitagawa Y et al (2000) Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232CrossRef

Kitagawa Y, Uno T, Oyama T et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 1. Esophagus 16:1–24CrossRef

Kitagawa Y, Uno T, Oyama T et al (2019) Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus 16:25–43CrossRef

Farjah F, Gerdes H, Gibson M, et al (2018) NCCN guidelines version 2. Esophageal and esophagogastric junction cancers NCCN evidence blockeTM. Available at: https://www.nccn.org/professionals/physician _gls/pdf/esophageal_blocks.pdf.

Kakeji Y, Takahashi A, Hasegawa H et al (2020) Surgical outcomes in gastroenterological surgery in Japan: report of the National clinical database 2011–2018. Ann Gastroenterol Surg 4:250–274CrossRef

Kato H, Sato A, Fukuda H et al (2009) A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan clinical oncology group study (JCOG9708). Jpn J Clin Oncol 39:638–643CrossRef

10.

Brierley JD, Gospodarowicz MK, Wittekind C (2017) TNM classification of malignant tumors, 8th edn. Wiley, Oxford, UK, pp 59–62

11.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRef

12.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

13.

Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. J Nat Cancer Inst 92:205–216CrossRef

14.

Eisenhauer E, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRef

15.

Mandard AM, Dalibard F, Mandard JC et al (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Cancer 73:2680–2686CrossRef

16.

National Cancer Institute. Cancer therapy evaluation program, common toxicity criteria. Version 5.0 National Cancer Institute; 2017. Last updated 27 March, 2020. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf

17.

The Japan Esophageal Society (2015) Japanese classification of esophageal cancer, 11th edn. Kanehara, Japan, pp 114–123

18.

Ando N, Kato H, Igaki H et al (2012) A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol 19:68–74CrossRef

19.

Takeuchi H, Miyata H, Gotoh M et al (2014) A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg 260:259–266CrossRef

20.

Booka E, Takeuchi H, Suda K et al (2018) Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open 2:276–284CrossRef

21.

Takeuchi H, Miyata H, Ozawa S et al (2017) Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol 24:1821–1827CrossRef

22.

Watanabe M, Okamura A, Tihata T et al (2018) Recent progress in perioperative management of patients undergoing esophagectomy for esophageral cancer. Esophagus 15:160–164CrossRef

23.

Steenhagen E, van Vulpen JK, van Hillegersberg R et al (2017) Nutrition in peri-operative esophageal cancer treatment. Expert Rev Gastroenterol Hepatol 11:663–672CrossRef

24.

Bolger JC, Loughney L, Tully R et al (2019) Perioperative prehabilitation and rehabilitation in esophagogastric malignancies: a systemic review. Dis Esophagus 32:1–11CrossRef

25.

Motoori M, Yano M, Ishihara R et al (2012) Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer. Ann Surg Oncol 19:2135–2141CrossRef

26.

Semenkovich TR, Hudson JL, Subramanian M et al (2019) Trends in treatment of T1N0 esophageal cancer. Ann Surg 270:434–443CrossRef

27.

Kato K, Igaki H, Nozaki I et al (2019) Parallel-group controlled trial of esophagectomy versus chemoradiotherapy in patients with clinical stage I esophageal carcinoma (JCOG0502). J Clin Oncol 37:7–7CrossRef

28.

Makazu M, Kato K, Takisawa H et al (2014) Feasibility of endoscopic mucosal resection as salvage treatment for patients with local failure after definitive chemoradiotherapy for stage IB, II, and III esophageal squamous cell cancer. Dis Esophagus 27:42–49CrossRef

29.

Yano T, Kasai H, Horimatsu T et al (2017) A multicenter phase II study of salvage photodynamic therapy using talaporfin sodium (ME2906) and diode laser (PNL6405EPG) for local failure after chemoradiotherapy or radiotherapy for esophageal cancer. Oncotarget 8:22135–22144CrossRef

30.

Akutsu Y, Kato K, Igaki H et al (2016) The prevalence of overall and initial lymph node metastasis in clinical T1N0 thoracic esophageal cancer: From the results of JCOG0502, a prospective multicenter study. Ann Surg 264:1009–1015CrossRef

31.

Lavin VJ, Mehta S, Sumra P et al (2018) Experience of definitive chemoradiation for oesophageal cancer within a large regional cancer treatment centre: improving outcomes and tolerability. Clin Oncol 30:650–657CrossRef

32.

Smit JK, Muijs CT, Burgerhof JG et al (2013) Survival after definitive (chemo) radiotherapy in esophageal cancer patients: a population-based study in the north-east Netherlands. Ann Surg Oncol 20:1985–1992CrossRef

33.

Choi J, Kim SG, Kim JS et al (2010) Comparison of endoscopic ultrasonography (EUS), positron emission tomography (PET), and computed tomography (CT) in the preoperative locoregional staging of resectable esophageal cancer. Surg Endosc 24:1380–1386CrossRef

Title: Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma
Authors: Ryoma Haneda
Eisuke Booka
Kenjiro Ishii
Hirotoshi Kikuchi
Yoshihiro Hiramatsu
Kinji Kamiya
Hirofumi Ogawa
Hirofumi Yasui
Hiroya Takeuchi
Yasuhiro Tsubosa
Publication date: 01-06-2021
Publisher: Springer International Publishing
Keywords: Esophagus Resection
Photodynamic Therapy
Esophagus Resection
Published in: World Journal of Surgery / Issue 6/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-021-06016-4

At a glance: The ONWARDS insulin icodec trials

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Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

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