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 13/2013

01-12-2013 | Thoracic Oncology

Multimodal Treatment Strategy for Clinical T3 Thoracic Esophageal Cancer

Authors: Hiroshi Saeki, MD, PhD, Masaru Morita, MD, PhD, Yasuo Tsuda, MD, Gen Hidaka, MD, Yuta Kasagi, MD, Hiroyuki Kawano, MD, Hajime Otsu, MD, Koji Ando, MD, PhD, Yasue Kimura, MD, PhD, Eiji Oki, MD, PhD, Tetsuya Kusumoto, MD, PhD, Yoshihiko Maehara, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2013

Login to get access

Abstract

Purpose

Our goal was to create a multimodal treatment strategy for patients with locally advanced esophageal cancer (EC).

Methods

A retrospective review identified a total of 193 patients with clinical T3 thoracic EC were categorized into 3 groups: 81 who had surgery only (group I); 102 who had planned neoadjuvant chemoradiotherapy (NACRT; group II); and 10 who had salvage esophagectomy after definitive chemoradiotherapy (dCRT; group III).

Results

Postoperative complications developed in 27, 45, and 80 % of patients in group I, group II, and group III, respectively. NACRT and dCRT were independent risk factors associated with postoperative complications; the odds ratios for group II and group III, compared with group I, were 2.1 and 8.8, respectively. The respective mortality rates were 4, 2, and 20 % (group I vs. group III, p < 0.05; group II vs. group III, p < 0.01). The 5-year survival rate was 25.2 % in group I and 41.6 % in group II. The 5-year survival rate in group II patients with markedly effective NACRT (89.2 %) was significantly better than in patients with ineffective/slightly effective (11.8 %; p < 0.0001) and moderately effective treatment (51 %; p < 0.05). Four patients who had noncurative surgery died within 4 months after salvage esophagectomy, whereas four of six patients were still alive after curative surgery.

Conclusions

A pathological complete response to NACRT is critical for improving survival in patients with clinical T3 thoracic EC. Salvage surgery should be considered only in carefully selected patients with locally advanced EC.
Literature
1.
Morita M, Yoshida R, Ikeda K, et al. Advances in esophageal cancer surgery in Japan: an analysis of 1000 consecutive patients treated at a single institute. Surgery. 2008;143:499–508. PubMedCrossRef
2.
Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999;17:2915–21.PubMed
3.
Kaneko K, Ito H, Konishi K, et al. Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus. Br J Cancer. 2003;88:18–24.PubMedCrossRef
4.
Crosby TD, Brewster AE, Borley A, Perschky L, Kehagioglou P, Court J, Maughan TS. Definitive chemoradiation in patients with inoperable oesophageal carcinoma. Br J Cancer. 2004;90:70–5.PubMedCrossRef
5.
Cooper JS, Guo MD, Herskovic A, 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.PubMedCrossRef
6.
Ando N, Kato H, Igaki H, et al. 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. 2012;19:68–74.PubMedCrossRef
7.
Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J. Australasian Gastro-Intestinal Trials Group. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol. 2007;8:226–34.PubMedCrossRef
8.
Fiorica F, Di Bona D, Schepis F, et al. Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis. Gut. 2004;53:925–30.PubMedCrossRef
9.
Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001;19:305–13.PubMed
10.
Burmeister BH, Smithers BM, Gebski V, et al. Trans-Tasman Radiation Oncology Group; Australasian Gastro-Intestinal Trials Group. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005;6:659–68.PubMedCrossRef
11.
Greer SE, Goodney PP, Sutton JE, Birkmeyer JD. Neoadjuvant chemoradiotherapy for esophageal carcinoma: a meta-analysis. Surgery. 2005;137:172–7.PubMedCrossRef
12.
Sai H, Mitsumori M, Araki N, Mizowaki T, Nagata Y, Nishimura Y, Hiraoka M. Long-term results of definitive radiotherapy for stage I esophageal cancer. Int J Radiat Oncol Biol Phys. 2005;62:1339–44.PubMedCrossRef
13.
Smith TJ, Ryan LM, Douglass HO, Jr., et al. Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 1998;42:269–76.PubMedCrossRef
14.
Anbai A, Koga M, Motoyama S, Jin M, Shibata H, Hashimoto M. Outcomes of patients with stage IVA esophageal cancer (Japanese classification) treated with definitive chemotherapy. Jpn J Radiol. 2013;31:270–6.PubMedCrossRef
15.
Sakuraba M, Kimata Y, Hishinuma S, Nishimura M, Gotohda N, Ebihara S. Importance of additional microvascular anastomosis in esophageal reconstruction after salvage esophagectomy. Plast Reconstr Surg. 2004;113:1934–9.PubMedCrossRef
16.
Urschel JD, Sellke FW. Complications of salvage esophagectomy. Med Sci Monit. 2003;9:RA173–80.PubMed
17.
Ishida K, Ando N, Yamamoto S, Ide H, Shinoda M. Phase II study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol. 2004;34:615–9.PubMedCrossRef
18.
Saeki H, Morita M, Nakashima Y, et al. Neoadjuvant chemoradiotherapy for clinical stage II-III esophageal squamous cell carcinoma. Anticancer Res. 2011;31:3073–7.PubMed
19.
Japan Esophageal Society (Ed.) Japanese classification of esophageal cancer, 10th edn. Tokyo: Kanehara Co. Ltd.; 2008.
20.
Yamabe Y, Kuroki Y, Ishikawa T, Miyakawa K, Kuroki S, Sekiguchi R. Tumor staging of advanced esophageal cancer: combination of double-contrast esophagography and contrast-enhanced CT. AJR Am J Roentgenol. 2008;191:753–7.PubMedCrossRef
21.
Morita M, Masuda T, Okada S, et al. Preoperative Chemoradiotherapy for esophageal cancer: factors associated with clinical response and postoperative complications. Anticancer Res. 2009;29:2555–62.PubMed
22.
Avendano CE, Flume PA, Silvesri GA, King LB, Reed CE. Pulmonary complications after esophagectomy. Ann Thorac Surg. 2002;73:922–6.PubMedCrossRef
23.
Fink U, Stein HJ, Wilke H, Roder JD, Siewert JR. Multimodal treatment for squamous cell esophageal cancer. World J Surg. 1995;19:198–204.PubMedCrossRef
24.
Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240:791–800.PubMedCrossRef
25.
Kelley ST, Coppola D, Karl RC. Neoadjuvant chemoradiotherapy is not associated with a higher complication rate vs. surgery alone in patients undergoing esophagectomy. J Gastrointest Surg. 2004;8:227–31, discussion 231–2.
26.
Lin FC, Durkin AE, Ferguson MK. Induction therapy does not increase surgical morbidity after esophagectomy for cancer. Ann Thorac Surg. 2004;78:1783–9.PubMedCrossRef
27.
Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ. Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg. 2007;94:1059–66.PubMedCrossRef
28.
Tachimori Y, Kanamori N, Uemura N, Hokamura N, Igaki H, Kato H. Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2009;137:49–54.PubMedCrossRef
29.
Morita M, Nakanoko T, Kubo N, et al. Two-stage operation for high-risk patients with thoracic esophageal cancer: an old operation revisited. Ann Surg Oncol. 2011;18:2613–21.PubMedCrossRef
30.
Oki E, Morita M, Kakeji Y, et al. Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Dis Esophagus. 2007;20:301–4.PubMedCrossRef
31.
Yoshida R, Morita M, Ando K, et al. Salvage esophagectomy after definitive chemoradiotherapy for synchronous double cancers of the esophagus and head-and-neck. Dis Esophagus. 2010;23:59–63.PubMedCrossRef
32.
Morita M, Kumashiro R, Hisamatsu Y, et al. Clinical significance of salvage esophagectomy for remnant or recurrent cancer following definitive chemoradiotherapy. J Gastroenterol. 2011;46:1284–91.PubMedCrossRef
33.
Saeki H, Masuda T, Okada S, et al. Impact of perioperative peripheral blood values on postoperative complications after esophageal surgery. Surg Today. 2010; 40:626–31.PubMedCrossRef
34.
Kato H, Miyazaki T, Nakajima M, Fukuchi M, Manda R, Kuwano H. Value of positron emission tomography in the diagnosis of recurrent oesophageal carcinoma. Br J Surg. 2004;91:1004–1009.PubMedCrossRef
35.
Luthra R, Luthra MG, Izzo J, et al. Biomarkers of response to preoperative chemoradiation in esophageal cancers. Semin Oncol. 2006;33:S2–5.PubMedCrossRef
Metadata
Title
Multimodal Treatment Strategy for Clinical T3 Thoracic Esophageal Cancer
Authors
Hiroshi Saeki, MD, PhD
Masaru Morita, MD, PhD
Yasuo Tsuda, MD
Gen Hidaka, MD
Yuta Kasagi, MD
Hiroyuki Kawano, MD
Hajime Otsu, MD
Koji Ando, MD, PhD
Yasue Kimura, MD, PhD
Eiji Oki, MD, PhD
Tetsuya Kusumoto, MD, PhD
Yoshihiko Maehara, MD, PhD
Publication date
01-12-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3192-2

Other articles of this Issue 13/2013

Annals of Surgical Oncology 13/2013 Go to the issue

Healthcare Policy and Outcomes

Quality Improvement in Colorectal Cancer in Local Health Integration Network 4 (LHIN 4) Project (QICC-L4): Integrated Knowledge Translation in a Large Geographic Region

Colorectal Cancer

Survival After Resection of Colorectal Cancer Based on Anatomical Segment of Involvement

Hepatobiliary Tumors

Comparison Between Perioperative and Postoperative Chemotherapy After Potentially Curative Hepatic Resection for Metastatic Colorectal Cancer

Melanomas

Undertreatment of Thick Head and Neck Melanomas: An Age-based Analysis

Gastrointestinal Oncology

Cytoreductive Surgery in Advanced GIST: Timing is Everything

Breast Oncology

Operative Risks Associated with Contralateral Prophylactic Mastectomy: A Single Institution Experience