Top

Radiation Oncology

Published in:

Open Access 01-12-2016 | Research

Prognostic factors in clinical T1N0M0 thoracic esophageal squamous cell carcinoma invading the muscularis mucosa or submucosa

Authors: Yusuke Uchinami, Miyako Myojin, Hiroaki Takahashi, Keiichi Harada, Shinichi Shimizu, Masao Hosokawa

Published in: Radiation Oncology | Issue 1/2016

Abstract

Background

Multimodality treatment is widely performed for clinical T1N0M0 (UICC-TNM classification, 7th edition) thoracic esophageal squamous cell carcinoma (ESCC), but available articles regarding treatment results are limited. This study assessed the outcomes of clinical T1N0M0 thoracic ESCC invading the muscularis mucosa (MM) or submucosa (SM) treated with radiotherapy (RT) or chemoradiotherapy (CRT).

Methods

We retrospectively reviewed the medical charts of 90 patients with clinical T1N0M0 thoracic ESCC treated with RT or CRT in our hospital in 2004–2011. Of these 90 patients, we analyzed the cases of 71 patients who met our inclusion criteria. All 71 patients had MM or SM cancer. In the 47 patients treated with CRT, the chemotherapy regimen of 5-fluorouracil (5-FU) plus cisplatin (CDDP) was used for 46 patients and 5-FU and nedaplatin was used for one patient. Forty-five patients underwent endoscopic resection (ER) followed by RT or CRT as an additional treatment. Elective nodal irradiation (ENI) was used in 39 patients. For all analyses, statistical significance was defined as 0.05, and the Bonferroni correction was used for the multivariate analysis.

Results

The median age was 70 years (range 47–84). With a median follow-up of 43.6 months (range 1.5–124.2), the 5-year overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) rates were 64.0, 72.8 and 50.0 %, respectively. The multivariate analysis showed that performance status (PS) was an independent prognostic factors for DSS and DFS (DSS, p < 0.001; DFS, p < 0.001). Chemotherapy in addition to RT showed a trend for better DSS (p = 0.032) but was not significant following Bonferroni correction. ER and ENI were not significant predictive factors for DSS and DFS.

Conclusions

PS was an independent prognostic factor for DSS and DFS. ER and ENI had no significant relationship with DSS or DFS. The present results may be helpful in treatment decisions for clinical T1N0M0 thoracic ESCC.

Available only for authorised users

Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, et al. Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. Gastrointest Endosc. 2009;70:860–6.CrossRefPubMed

Repici A, Hassan C, Carlino A, Pagano N, Zullo A, Rando G, et al. Endoscopic submucosal dissection in patients with early esophageal squamous cell carcinoma: results from a prospective Western series. Gastrointest Endosc. 2010;71:715–21.CrossRefPubMed

Motoori M, Yano M, Ishihara R, Yamamoto S, Kawaguchi Y, Tanaka K, et al. Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer. Ann Surg Oncol. 2012;19:2135–41.CrossRefPubMed

Yamamoto S, Ishihara R, Motoori M, Kawaguchi Y, Uedo N, Takeuchi Y, et al. Comparison between definitive chemoradiotherapy and esophagectomy in patients with clinical stage I esophageal squamous cell carcinoma. Am J Gastroenterol. 2011;106:1048–54.CrossRefPubMed

Kurokawa Y, Muto M, Minashi K, Boku N, Fukuda H, et al. A phase II trial of combined treatment of endoscopic mucosal resection and chemoradiotherapy for clinical stage I esophageal carcinoma: Japan Clinical Oncology Group Study JCOG0508. Jpn J Clin Oncol. 2009;39:686–9.CrossRefPubMedPubMedCentral

Motoyama S, Jin M, Matsuhashi T, Nanjo H, Ishiyama K, Sato Y, et al. Outcomes of patients receiving additional esophagectomy after endoscopic resection for clinically mucosal, but pathologically submucosal, squamous cell carcinoma of the esophagus. Surg Today. 2013;43:638–42.CrossRefPubMed

Akutsu Y, Uesato M, Shuto K, Kono T, Hoshino I, Horibe D, et al. The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 patients. Ann Surg. 2013;257:1032–8.CrossRefPubMed

Yamashina T, Ishihara R, Nagai K, Matsuura N, Matsui F, Ito T, et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol. 2013;108:544–51.CrossRefPubMed

Eguchi T, Nakanishi Y, Shimoda T, Iwasaki M, Igaki H, Tachimori Y, et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol. 2006;19:475–80.CrossRefPubMed

10.

Shimizu Y, Kato M, Yamamoto J, Nakagawa S, Tsukagoshi H, Fujita M, et al. EMR combined with chemoradiotherapy: a novel treatment for superficial esophageal squamous-cell carcinoma. Gastrointest Endosc. 2004;59:199–204.CrossRefPubMed

11.

Kawaguchi G, Sasamoto R, Abe E, Ohta A, Sato H, Tanaka K, et al. The effectiveness of endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer. Radiat Oncol. 2015;10:31.CrossRefPubMedPubMedCentral

12.

Tanabe S, Myojin M, Shimizu S, Fujino M, Takahashi H, Shirato H, et al. Dose-volume analysis for respiratory toxicity in intrathoracic esophageal cancer patients treated with definitive chemoradiotherapy using extended fields. J Radiat Res. 2013;54:1085–94.CrossRefPubMedPubMedCentral

13.

Japanese Society for Esophageal Diseases. Japanese classification of esophageal cancer, tenth edition: part II and III. Esophagus. 2009;6:71–94.CrossRef

14.

Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA, Al-Sarraf M, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85–01). Radiation Therapy Oncology Group. JAMA. 1999;281:1623–7.CrossRefPubMed

15.

Di Fiore F, Lecleire S, Rigal O, Galais MP, Ben Soussan E, David I, et al. Predictive factors of survival in patients treated with definitive chemoradiotherapy for squamous cell esophageal carcinoma. World J Gastroenterol. 2006;12:4185–90.CrossRefPubMedPubMedCentral

16.

Clavier JB, Antoni D, Atlani D, Ben Abdelghani M, Schumacher C, Dufour P, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus. 2014;27:560–7.CrossRefPubMed

17.

Kodaira T, Fuwa N, Tachibana H, Nakamura T, Tomita N, Nakahara R, et al. Retrospective analysis of definitive radiotherapy for patients with superficial esophageal carcinoma: Consideration of the optimal treatment method with a focus on late morbidity. Radiother Oncol. 2010;95:234–9.CrossRefPubMed

18.

Kuwano H, Nishimura Y, Oyama T, Kato H, Kitagawa Y, Kusano M, et al. Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.CrossRefPubMed

19.

Thosani N, Singh H, Kapadia A, Ochi N, Lee JH, Ajani J, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: a systematic review and meta-analysis. Gastrointest Endosc. 2012;75:242–53.CrossRefPubMed

20.

Rampado S, Bocus P, Battaglia G, Ruol A, Portale G, Ancona E. Endoscopic ultrasound: accuracy in staging superficial carcinomas of the esophagus. Ann Thorac Surg. 2008;85:251–6.CrossRefPubMed

21.

Yamashita H, Okuma K, Wakui R, Kobayashi-Shibata S, Ohtomo K, Nakagawa K. Details of recurrence sites after elective nodal irradiation (ENI) using 3D-conformal radiotherapy (3D-CRT) combined with chemotherapy for thoracic esophageal squamous cell carcinoma — a retrospective analysis. Radiother Oncol. 2011;98:255–60.CrossRefPubMed

22.

Onozawa M, Nihei K, Ishikura S, Minashi K, Yano T, Muto M, et al. Elective nodal irradiation (ENI) in definitive chemoradiotherapy (CRT) for squamous cell carcinoma of the thoracic esophagus. Radiother Oncol. 2009;92:266–9.CrossRefPubMed

23.

Zhao KL, Ma JB, Liu G, Wu KL, Shi XH, Jiang GL. Three-dimensional conformal radiation therapy for esophageal squamous cell carcinoma: is elective nodal irradiation necessary? Int J Radiat Oncol Biol Phys. 2010;76:446–51.CrossRefPubMed

Title: Prognostic factors in clinical T1N0M0 thoracic esophageal squamous cell carcinoma invading the muscularis mucosa or submucosa
Authors: Yusuke Uchinami
Miyako Myojin
Hiroaki Takahashi
Keiichi Harada
Shinichi Shimizu
Masao Hosokawa
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2016
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-016-0660-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic factors in clinical T1N0M0 thoracic esophageal squamous cell carcinoma invading the muscularis mucosa or submucosa

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

The dosimetric impact of implants on the spinal cord dose during stereotactic body radiotherapy

Inhalative steroids as an individual treatment in symptomatic lung cancer patients with radiation pneumonitis grade II after radiotherapy – a single-centre experience

Contribution of submandibular gland and swallowing structure sparing to post-radiation therapy PEG dependence in oropharynx cancer patients treated with split-neck IMRT technique

Feasibility study of DCs/CIKs combined with thoracic radiotherapy for patients with locally advanced or metastatic non-small-cell lung cancer

Involved-field radiotherapy for esophageal squamous cell carcinoma: theory and practice

Outcomes of patients with loco-regionally recurrent or new primary squamous cell carcinomas of the head and neck treated with curative intent reirradiation at Mayo Clinic