Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy

Objective: This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT. Summary backgr...

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Published in:Therapeutic advances in medical oncology 2022, Vol.14, p.17588359221108693-17588359221108693
Main Authors: Gao, Lin-Rui, Li, Chen, Han, Weiming, Ni, Wenjie, Deng, Wei, Tan, Lijun, Zhou, Zongmei, Chen, Dongfu, Feng, Qinfu, Liang, Jun, Lv, Jima, Wang, Wenqing, Liu, Wenyang, Deng, Lei, Wang, Xin, Zhang, Tao, Wang, Jianyang, Zhai, Yirui, Bi, Nan, Wang, Lvhua, Hui, Zhouguang, Li, Ye-Xiong, Xiao, Zefen
Format: Article
Language:English
Subjects:
Chemoradiotherapy
Chemotherapy
Complications
Esophageal cancer
Esophagus
Original Research
Patients
Postoperative
Radiation therapy
Squamous cell carcinoma
Surgery
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Summary:Objective: This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT. Summary background data: Treatment options for cT4 EC include dCRT/RT and nCRT/RT + S, but it is not clear whether the latter provides survival benefit in patients downstaged after nCRT/RT. Methods: From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma (ESCC) were retrospectively analyzed. Patients achieving clinical complete response (cCR) or partial response (PR) after 4-week RT (median dose, 40.7 Gy) and considered fit for surgery were offered esophagectomy. Of the 726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received subsequent surgery (nCRT/RT + S group), 234 patients received dCRT/RT. Results: Median follow-up was 58 months. The 3-year overall survival (OS) and progression-free survival (PFS) rates for all patients were 33.3% and 35.6%, respectively. The corresponding OS and PFS rates were 54.8% and 48.5% in the nCRT/RT + S group versus 30.0% and 22.1% in the dCRT/RT group (both p 
ISSN:1758-8359
1758-8340
1758-8359
DOI:10.1177/17588359221108693