Multimodal treatment strategy for clinical T3 thoracic esophageal cancer

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

Research output: Contribution to journalArticlepeer-review

14 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)4267-4273
Number of pages7
JournalAnnals of Surgical Oncology
Volume20
Issue number13
DOIs
Publication statusPublished - Aug 14 2013

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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