Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2013

01-06-2013 | Thoracic Oncology

Postchemoradiation Resected Locally Advanced Esophageal and Gastroesophageal Junction Carcinoma: Long-Term Outcome With or Without Intraoperative Radiotherapy

Authors: Felipe A. Calvo, MD, PhD, Claudio V. Sole, MD, Rosángela Obregón, MD, PhD, Marina Gómez-Espí, MD, Miguel A. Lozano, MD, Luis Gonzalez-Bayon, MD, PhD, Jose Luis García-Sabrido, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2013

Login to get access

Abstract

Background

To report feasibility, tolerance, anatomical topography of locoregional recurrence (LRR), and long-term outcome for esophageal and esophagogastric (EG) cancer patients treated with preoperative chemoradiation (CRT) and surgery with or without a radiation boost of intraoperative electron beam radiotherapy (IOERT).

Methods

From January 1995 to December 2010, 53 patients with primary esophageal (n = 26; 44 %) or EG carcinoma (n = 30; 56 %), and disease confined to locoregional area [clinical stage: IIb (n = 30; 57 %), IIIa (n = 14; 26 %), IIIb (n = 6; 11 %), IIIc (n = 3; 6 %)], were treated with preoperative CRT, curative (R0) resection with an extended (two-field) lymph node dissection in all cases. Thirty-seven patients also received a preanastomotic reconstruction IOERT boost (applicator diameter size 6–9 cm, dose 10–15 Gy, beam energy 6–15 MeV) over the tumor bed in the mediastinum and upper abdominal lymph node area.

Results

With a median follow-up time of 27.9 months (range, 0.2–148), LRR rate was 15 % (n = 8). Five-year overall survival (OS) and disease-free survival was 48 and 36 %, respectively. Univariate log-rank analyses showed that receiving IOERT was associated with lower risk of LRR (p = 0.004). On multivariate analysis, only the IOERT group retained significance in relation to LRR (odds ratio, 0.08; 95 % confidence interval, 0.01–0.48; p = 0.01). Postoperative mortality and perioperative complications were 11 % (n = 6) and 30 % (n = 16).

Conclusions

Local control is high in the radiation-boosted area, but OS remains modest, given the high risk of distant metastases. Intensified locoregional treatment needs to be tested in the context of more efficient concurrent, neo-, and adjuvant systemic therapy.
Literature
1.
Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE. Long-term results of a randomized trial with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol. 2009;27:5062–7.PubMedCrossRef
2.
Akiyama H, Tsurumaru M, Kawamura T, Ono Y. Principles of surgical treatment of carcinoma of the esophagus: analysis of lymph node involvement. Ann Surg. 1981;194:438–46.PubMedCrossRef
3.
Isono K, Sato H, Nakayama K. Results of a nationwide study on the three-field lymph node dissection of esophageal cancer. Oncology. 1991;48:411–20.PubMedCrossRef
4.
Collard JM, Otte JB, Reynaert MS, Michel LA, Malaise JF, Lengele BG, et al. Extensive lymph node clearance for cancer of the esophagus or cardia: merits in reference to 5-year absolute survival. Hepatogastroenterology. 1995;42:619–27.PubMed
5.
Nishimaki T, Tanaka O, Suzuki T, Aizawa K, Hatakeyama K, Muto T, et al. Clinical implications of cervical lymph node metastasis patterns in thoracic esophageal cancer. Ann Surg. 1994;20:775–81.CrossRef
6.
Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg. 1995;222:654–62.PubMedCrossRef
7.
Altorki NK, Skinner DB. Occult cervical nodal metastasis in esophageal cancer: preliminary results of three-field lymphadenectomy. J Thorac Cardiovasc Surg. 1997;113:540–4.PubMedCrossRef
8.
Mariette C, Piessen G, Triboulet J-P. Therapeutic strategies in esophageal carcinoma: role of surgery and other modalities. Lancet Oncol. 2007;8:545–53.PubMedCrossRef
9.
Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study—JCOG9204. J Clin Oncol. 2003;21:4592–6.PubMedCrossRef
10.
Arnott SJ, Duncan W, Gignoux M, et al. Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev. 2005;4:CD001799.
11.
Zieren HU, Muller JM, Jacobi CA, Pichlmaier H, Muller RP, Staar S. Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study. World J Surg. 1995;19:444–9.PubMedCrossRef
12.
Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RH, Barbour A, Gebski V. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2001;12:681–92.CrossRef
13.
Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol. 2008;26:1086–92.PubMedCrossRef
14.
Walsh TN, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TP. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335:462–7.PubMedCrossRef
15.
Minsky BD, Pajak TF, Ginsberg RJ, et al. 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. 2002;20:1167–74.PubMedCrossRef
16.
Fletcher G. Clinical dose-response curves of human malignant epithelial tumours Br J Radiol. 1973;46:1–12.
17.
Gunderson LL, Willet CG, Calvo FA, Harrison LB. Intraoperative irradiation techniques and results. In: Okunnief P, Sundararaman S, Metcalfe S, Chen Y, editors. Biology of large dose per fraction irradiation vol. 2. 2nd edn. Current Clinical Oncology. Totowa: Humana Press; 2011. p. 27–50.
18.
Hosokawa M, Shirato H, Ohara M, et al. Intraoperative radiation therapy to the upper mediastinum and nerve-sparing three-field lymphadenectomy followed by external beam radiotherapy for patients with thoracic esophageal carcinoma. Cancer. 1999;86:6–13.PubMedCrossRef
19.
Murakami M, Kuroda Y, Nakajima T, et al. Intraoperative radiotherapy for the abdominal lymphatic system in patients with esophageal carcinoma. Dis Esophagus. 1999;12:270–5.PubMedCrossRef
20.
Miller RC, Haddock MG, Gunderson LL, Donohue JH, Trastek VF, Alberts SR, Deschamps C. Intraoperative radiotherapy for treatment of locally advanced and recurrent esophageal and gastric adenocarcinomas. Dis Esophagus. 2006;19:487–95.PubMedCrossRef
21.
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;21:1662–9.CrossRef
22.
Visbal AL, Allen MS, Miller DL, Deschamps C, Trastek VF, Pairolero PC. Ivor Lewis esophagogastrectomy for esophageal cancer. Ann Thorac Surg. 2001;71:1803–8.PubMedCrossRef
23.
Orringer MB, Marshall B, Chang AC, Lee J, MS, Pickens A, Lau CL. Two thousand transhiatal esophagectomies. Changing trends, lessons learned. Ann Surg. 2007;246:363–74.
24.
Hagen JA, Peters JH, DeMeester TR. Superiority of extended en bloc esophagogastrectomy for carcinoma of the lower esophagus and cardia. J Thorac Cardiovasc Surg. 1993;106:850–8.PubMed
25.
Pascau J, Santos Miranda JA, Calvo FA, Bouché A, Morillo V, González-San Segundo C, Ferrer C, López Tarjuelo J, Desco M. An innovative tool for intraoperative electron beam radiotherapy simulation and planning: description and initial evaluation by radiation oncologists. Int J Radiat Oncol Biol Phys. 2012;83:287–95.
26.
Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.PubMedCrossRef
27.
Stahl M, Walz MK, Stuschke M, Lehmann N, Meyer HJ, Riera-Knorrenschild J, Langer P, Engenhart-Cabillic R, Bitzer M, Königsrainer A, Budach W, Wilke H. Phase III comparison of preoperative chemotherapy compared with chemoradiotherapy in patients with locally advanced adenocarcinoma of the esophagogastric junction. J Clin Oncol. 2009;20:851–6.CrossRef
28.
Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310–7.PubMedCrossRef
29.
Azinovic I, Calvo FA, Puebla F, Aristu J, Martínez-Monge R. Long-term normal tissue effects of intraoperative electron radiation therapy (IOERT): late sequelae, tumor recurrence, and second malignancies. Int J Radiat Oncol Biol Phys. 2001;49:597–604.PubMedCrossRef
30.
Birkmeyer JD, Siewers AE, Finlayson E, et al. Hospital volume and surgical mortality in the United States. N Eng J Med. 2002;346:1128–37.CrossRef
31.
Nguyen NT, Follette DM, Lemoine PH, Roberts PF, Goodnight JE Jr. Minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg. 2001;72:593–6.PubMedCrossRef
32.
Lin SH, Wang L, Myles B, Thall PF, Hofstetter WL, Swisher SG, Ajani JA, Cox JD, Komaki R, Liao Z. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs intensity-modulated radiotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys. 2012;84:1078–85.
33.
Song YP, Ma JB, Hu LK, Zhou W, Chen EC, Zhang W. Phase I/II study of hypofractioned radiation with three-dimensional conformal radiotherapy for clinical T3-4N0-1M0 stage esophageal carcinoma. Technol Cancer Res Treat. 2011;10:25–30.PubMed
Metadata
Title
Postchemoradiation Resected Locally Advanced Esophageal and Gastroesophageal Junction Carcinoma: Long-Term Outcome With or Without Intraoperative Radiotherapy
Authors
Felipe A. Calvo, MD, PhD
Claudio V. Sole, MD
Rosángela Obregón, MD, PhD
Marina Gómez-Espí, MD
Miguel A. Lozano, MD
Luis Gonzalez-Bayon, MD, PhD
Jose Luis García-Sabrido, MD, PhD
Publication date
01-06-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2810-8

Other articles of this Issue 6/2013

Annals of Surgical Oncology 6/2013 Go to the issue

Gastrointestinal Oncology

Neoadjuvant Concurrent Chemoradiotherapy for Locally Advanced Esophageal Cancer in a Single High-Volume Center

Endocrine Tumors

A Systematic Review and Meta-analysis Comparing the Efficacy and Surgical Outcomes of Total Thyroidectomy Between Harmonic Scalpel Versus Ligasure

Urologic Oncology

Effect of Nodal Metastases on Cancer-specific Mortality After Cytoreductive Nephrectomy

Healthcare Policy and Outcomes

Comprehensive Databases: A Cautionary Note

Bone and Soft Tissue Sarcomas

Predictors of Survival and Recurrence in Primary Leiomyosarcoma

Thoracic Oncology

Predictors for Locoregional Recurrence for Clinical Stage III-N2 Non-small Cell Lung Cancer with Nodal Downstaging After Induction Chemotherapy and Surgery