Prognostic impact of circumferential resection margin in esophageal cancer with or without neoadjuvant chemoradiotherapy

2020 ◽  
Vol 33 (9) ◽  
Author(s):  
C-Y Liu ◽  
P-K Hsu ◽  
H-S Hsu ◽  
Y-C Wu ◽  
C-Y Chuang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Esophageal Squamous Cell Carcinoma ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Neoadjuvant Chemoradiotherapy ◽  
Prognostic Impact ◽  
Medical Centers ◽  
Surgery Group

Summary The prognostic impact of circumferential resection margin (CRM) in surgically resected esophageal squamous cell carcinoma (ESCC) has been controversial. This investigation assessed the prognostic impact of CRM in surgically resected pathologic T3 ESCC patients with or without neoadjuvant chemoradiotherapy (nCRT). We reviewed consecutive p/yp T3 ESCC patients undergoing esophagectomy from two medical centers between January 2009 and December 2016. The cohort was divided into two groups: upfront esophagectomy (upfront surgery) and nCRT followed by esophagectomy (nCRT + surgery). CRM status was assessed and divided into CRM > 1 mm, 0 < CRM < 1 mm, and tumor at CRM. A total of 217 p/yp T3 ESCC patients undergoing esophagectomy (138 patients in the upfront surgery group and 79 in the nCRT + surgery group) were enrolled. In the upfront surgery group, patients with 0 < CRM < 1 mm showed equivalent overall survival to those with CRM > 1 mm (log-rank P = 0.817) and significantly outlived those with tumor at CRM (log-rank P < 0.001). However, in the nCRT + surgery group, CRM > 1 mm failed to show survival superiority to CRM between 0 and 1 mm or involved by cancer (log-rank P = 0.390). In conclusion, a negative CRM, even though being <1 mm, is adequate for pT3 ESCC patients undergoing upfront esophagectomy. In contrast, the CRM status is less prognostic in ypT3 ESCC patients undergoing nCRT followed by esophagectomy.

scholarly journals Predictors of Survival in Esophageal Squamous Cell Carcinoma with Pathologic Major Response after Neoadjuvant Chemoradiation Therapy and Surgery: The Impact of Chemotherapy Protocols

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Chia-Ying Li ◽  
Pei-Ming Huang ◽  
Pei-Yi Chu ◽  
Po-Ming Chen ◽  
Mong-Wei Lin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Disease Progression ◽  
Cancer Patients ◽  
Chemoradiation Therapy ◽  
Major Response

Tumor recurrence is an important problem threatening esophageal cancer patients after surgery, even when they achieve a pathologic major response (pMR) after neoadjuvant concurrent chemoradiation therapy (CCRT). The predictors related to overall survival and disease progression for these patients remain elusive. We aimed to identify factors that predict disease progression and overall survival in esophageal squamous cell carcinoma (SCC) patients who achieve a pMR after neoadjuvant CCRT followed by surgery. We conducted a retrospective study to analyze the factors influencing survival and disease progression after esophagectomy for esophageal cancer patients who had a major response to CCRT, which is defined by complete pathological response or microscopic residual disease without lymph node metastasis. From our study cohort, 285 patients underwent CCRT and subsequent esophagectomy; 171 (60%) of these patients achieved pMR. After excluding patients with lymph node metastases, incomplete clinical data, and adenocarcinomas, we enrolled 117 patients in this study. We found that the CCRT regimen was the only factor that influenced overall survival. The overall survival of the patients receiving taxane-incorporated CCRT was superior to that of patients receiving traditional cisplatin and 5-fluorouracil (PF) (P=0.011). The CCRT regimen can significantly influence the clinical outcome of esophageal SCC patients who achieve pMR after neoadjuvant CCRT and esophagectomy. Incorporation of taxanes into cisplatin-based CCRT may be associated with prolonged survival.

New 3-Tiered Circumferential Resection Margin Criteria in Esophageal Squamous Cell Carcinoma

2015 ◽  
Vol 262 (6) ◽  
pp. 965-971 ◽  
Author(s):  
Geun Dong Lee ◽  
Seung Eun Lee ◽  
Kyoung-Mee Kim ◽  
Yong-Hee Kim ◽  
Joong Hyun Ahn ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Circumferential Resection Margin ◽  
Resection Margin

Comparison of definitive chemoradiotherapy and esophagectomy for stage I esophageal squamous cell carcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 67-67
Author(s):  
S. Yamamoto ◽  
R. Ishihara ◽  
M. Motoori ◽  
Y. Kawaguchi ◽  
Y. Takeuchi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Local Recurrence ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Stage I ◽  
High Local Recurrence Rate

67 Background: Chemoradiotherapy (CRT) of esophageal cancer has been proposed as an alternative to esophagectomy given the favourable survival rate and mild toxicity. However, no comparative study is reported between esophagectomy and CRT in stage I esophageal squamous cell carcinoma. Methods: A total of 54 patients treated by definitive CRT and 116 patients treated by esophagectomy at out institution between February 1995 and August 2008 were included in the analysis. Overall survival and recurrence rates were evaluated. Results: Of 170 patients who had clinical stage I esophageal squamous cell carcinoma and treated by definitive CRT or esophagectomy, 169 patients (99%) were completely followed up. CRT mainly consisted of two cycles of cisplatin and fluorouracil with concurrent radiotherapy of 60 Gy in 30 fractions. Median (range) observation period was 67 (10–171) months in SURG group and 30 (4–77) months in CRT group. In CRT group grade 3 or grade 4 hematological or non-hematological adverse effects were seen in 24 (44.4%) patients. 1-year and 3-year overall survival rates were 97.4% and 85.5% in the SURG group and 98.1% and 88.7% in the CRT group (P = 0.78). By using Cox proportional hazards modelling, overall survival was comparable between the 2 groups after adjusting for age, sex, and size of cancer. Hazard ratio of CRT for overall survival was 0.95 (95% CI: 0.37-2.47). The incidence or local recurrence including metachronous esophageal cancer was significantly higher in the CRT group than the SURG group (P < 0.0001). All recurrences were intramucosal carcinomas and all of them were cured after the salvage treatment mainly using endoscopy. Conclusions: Overall survival rate of CRT was comparable with esophagectomy despite high local recurrence rate. Local recurrent carcinoma is endoscopically treatable in all patients without influence on overall survival. CRT appears to be a reasonable alternative to esophagectomy in patients with stage I esophageal cancer. No significant financial relationships to disclose.

Outcome of chemoradiotherapy followed by surgery for locally advanced T4 thoracic esophageal squamous cell carcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 170-170
Author(s):  
Yasunori Akutsu ◽  
Tsuguaki Kono ◽  
Masaya Uesato ◽  
Isamu Hoshino ◽  
Kentaro Murakami ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Primary Tumor ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Surgery Group ◽  
Cause Specific Survival

170 Background: Chemoradiotherapy (CRT) is a standard modality for locally advanced esophageal squamous cell carcinoma (ESCC). The outcome of CRT with/without following surgery for locally advanced ESCC was demonstrated. Methods: 1,235 new ESCC patients from 2001 to 2012 were obtained. From these, locally advanced thoracic ESCC was selected. If the patients showed resectability with down-staging after CRT, a subsequent surgery was performed. For the remaining cases, an additional CRT was prescribed, following by a re-evaluation for surgery. If down-staging and resectability were achieved, the patients underwent surgery. In the surgery group, pathologic effectiveness in the primary tumor and lymph nodes was observed and survivals both in surgery and non-surgery group were calculated. Results: From 1,235 new ESCC patients, 153 patients (12.4%) were of locally advanced thoracic ESCC. Among these, 28 patients (18.3%) showed finally down-staging of the primary tumor and could undergo following surgery. 12 patients (7.8%) could obtain down-staging and underwent surgery (surgery H group). In total, 40 patients (26.1%) could undergo surgery (surgery group). The rate of residual tumor in the primary tumor was detected in 32 cases (80%). The 5-year overall survival was 33.0% in the surgery group and 10.0% in the non-surgery group (P=0.002). The 5-year cause-specific survival was 65.0% in the surgery group and 18.1% in the non-surgery group (P=0.002). Conclusions: CRT for locally advanced thoracic ESCC is the standard modality and following surgery have benefits. However, the outcome is not satisfactory and further improvements of treatments for such cases are requested.

FA03.04: ACTIVE SURVEILLANCE VS SURGERY IN CLINICALLY COMPLETE RESPONDERS AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: A PROPENSITY-MATCHED STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 7-7
Author(s):  
Berend Van Der Wilk ◽  
Lisanne Neijenhuis ◽  
B Noordman ◽  
Grard A P Nieuwenhuijzen ◽  
M N Sosef ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Propensity Score ◽  
Active Surveillance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Surgery Group ◽  
Significant Difference ◽  
Matched Study ◽  
Dissemination Rate

Abstract Background Nearly one third of esophageal cancer patients show a pathologically complete response in their resection specimens after neoadjuvant chemoradiotherapy (nCRT) according to CROSS regimen. This raises questions whether all patients benefit from surgery or if active surveillance can be applied to patients with a clinically complete response (cCR) after nCRT. This retrospective-multicenter propensity matched study compared outcomes of patients with a cCR after nCRT undergoing active surveillance or standard surgery. Methods Patients that refused surgery after nCRT between 2012–2017 from 4 hospitals were included. For the standard surgery group, patients from the preSANO trial were enrolled. A cCR was defined as endoscopies with multiple (bite-on-bite) biopsies, EUS-FNA and PET-CT showing no residual disease 6 and 12 weeks after completion of nCRT. Optimal propensity-score matching generated a matched cohort (1:2) matched for age, comorbidities, cT, cN, histology of the tumor and biopsy type. For comparison of severity of complications according to Clavien-Dindo (CD) classification, a separate optimal propensity-score matching cohort was generated (1:2) for all patients in the active surveillance group that underwent surgery. Primary outcome was overall survival, secondary outcomes were rate of radically resected tumors, distant dissemination rate and rate of postoperative complications according to the CD-classification. Results 75 patients were identified of whom 50 patients underwent standard surgery and 25 patients underwent active surveillance. 13 of 25 patients in the active surveillance group underwent surgery for locoregional recurrent disease. Median follow-up was 23.7 months for the standard surgery group and 18.8 months for the active surveillance group. There was no statistically significant difference between the groups in overall survival (HR = 0.48, 95%C.I. 0.10–2.2, P = 0.96). In both groups, all tumors were radically resected. There were no statistically significant differences in distant dissemination rate between the active surveillance and standard surgery group (16.0% versus 22.0%, P = 0.76) or in severity of complications (CD ≥ 3;46.2% versus 23.1%, P = 0.16). Conclusion There was no statistically significant difference in overall survival, distant dissemination rate and severity of complications between patients undergoing standard surgery or active surveillance after nCRT. However, since sample sizes were small, especially for the severity of complications, these results should be interpreted with caution. Disclosure All authors have declared no conflicts of interest.

RA03.04: COMPARISON OF THE CLINICAL OUTCOMES OF ESOPHAGECTOMY AND CHEMORADIOTHERAPY AFTER NONCURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 23-23
Author(s):  
Yasufumi Koterazawa ◽  
Tetsu Nakamura ◽  
Taro Oshikiri ◽  
Shingo Kanaji ◽  
Kimihiro Yamashita ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Tumor Invasion ◽  
Lymphovascular Invasion ◽  
Definitive Treatment

Abstract Background Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional definitive treatment owing to the possibility of residual tumor cells or lymph node metastasis. The aim of this study was to elucidate the efficacy and clinical outcomes of these additional treatments. Methods ESD was performed for cT1a esophageal cancer, and additional definitive treatment was recommended for patients who had undergone noncurative ESD for submucosa (SM) or muscularis mucosae cancers with lymphovascular invasion and a positive resection margin. The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy with lymph node dissection and 31 received chemoradiotherapy (CRT) by choice or because their conditions did not permit surgery. Results The median follow-up periods were 45 months (range, 3–89 months) in the esophagectomy group and 41 months (range, 12–84 months) in the CRT group. Overall survival didn’t differ between the groups (P = 0.46). But there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence owing to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, 6 patients; CRT group, 10 patients), none in the esophagectomy group had a recurrence, whereas 4 in the CRT group died of esophageal cancer (P = 0.031). Conclusion Overall survival did not differ between the esophagectomy and CRT groups after noncurative ESD. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion. Disclosure All authors have declared no conflicts of interest.

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