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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2015

01-06-2015 | Thoracic Oncology

Comparison of Transthoracic Esophagectomy with Definitive Chemoradiotherapy as Initial Treatment for Patients with Esophageal Squamous Cell Carcinoma Who Could Tolerate Transthoracic Esophagectomy

Authors: Satoru Matsuda, MD, Yasuhiro Tsubosa, MD, PhD, Masahiro Niihara, MD, Hiroshi Sato, MD, PhD, Katsushi Takebayashi, MD, PhD, Keisuke Kawamorita, MD, Keita Mori, MSc, Takahiro Tsushima, MD, Tomoya Yokota, MD, PhD, Hirofumi Ogawa, MD, Yusuke Onozawa, MD, Hirofumi Yasui, MD, Hiroya Takeuchi, MD, PhD, Yuko Kitagawa, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2015

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Abstract

Background

The oncological outcomes of transthoracic esophagectomy (TTE) and definitive chemoradiotherapy (dCRT) as initial treatment in patients with esophageal squamous cell carcinoma (ESCC) who could tolerate TTE remains unclear.

Methods

Consecutive patients histologically diagnosed with stage I/II/III ESCC (excluding cT4 or cN3) or stage IV ESCC due to supraclavicular lymph node metastasis were eligible for inclusion in this retrospective study. To select patients who could tolerate TTE, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. Patient characteristics, recurrence-free survival (RFS), 3- and 5-year overall survival (OS), pattern of recurrence, and treatments after initial treatment failure were investigated.

Results

Overall, 112 patients were included in the TTE group and 65 were included in the dCRT group. No significant differences were observed in patient characteristics and clinical stage between the TTE and dCRT groups (stage I/II/III/IV of 29/27/46/10 in the TTE group and 23/15/20/7 in the dCRT group). The R0 resection rate was 87 % in the TTE group, and complete response rate was 68 % in the dCRT group. In intention-to-treat analysis, there was no significant difference in RFS. In contrast, 3-year OS of non-stage IA patients was significantly longer in the TTE group than the dCRT group (TTE 66.9 %; dCRT 49.8 %; p = 0.023). In non-stage IA patients, after initial treatment failure significantly more patients could undergo local treatment (radiotherapy or surgery in the TTE group; surgery or endoscopic resection or photodynamic therapy in the dCRT group) in the TTE group than the dCRT group (TTE 74 %; dCRT 40 %; p = 0.003).

Conclusions

In locally advanced ESCC patients who could tolerate TTE, TTE extended 3-year OS, which might have been encouraged by utilizing local treatment after initial treatment failure.
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Metadata
Title
Comparison of Transthoracic Esophagectomy with Definitive Chemoradiotherapy as Initial Treatment for Patients with Esophageal Squamous Cell Carcinoma Who Could Tolerate Transthoracic Esophagectomy
Authors
Satoru Matsuda, MD
Yasuhiro Tsubosa, MD, PhD
Masahiro Niihara, MD
Hiroshi Sato, MD, PhD
Katsushi Takebayashi, MD, PhD
Keisuke Kawamorita, MD
Keita Mori, MSc
Takahiro Tsushima, MD
Tomoya Yokota, MD, PhD
Hirofumi Ogawa, MD
Yusuke Onozawa, MD
Hirofumi Yasui, MD
Hiroya Takeuchi, MD, PhD
Yuko Kitagawa, MD, PhD
Publication date
01-06-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 6/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4337-7

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