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Treatment results of neoadjuvant chemoradiotherapy followed by radical esophagectomy in patients with initially inoperable thoracic esophageal cancer

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Abstract

Purpose

We evaluated the effectiveness of neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy for cT4 esophageal cancer or lymph node metastases (LNM) invading adjacent structures.

Materials and methods

We retrospectively evaluated 42 consecutive patients with thoracic esophageal cancer who underwent CRT followed by esophagectomy between 2008 and 2013. All were initially considered to be unresectable because of cT4 (n = 32) disease or LN invasion (n = 10). Radiotherapy was administered at 41.4 Gy/23 fr with concurrent chemotherapy. At completion of CRT, restaging was performed using computed tomography (CT).

Results

All cT4 tumors were downstaged, LNM invading to adjacent structures were considered to be released, and subtotal esophagectomy was performed. The median follow-up period was 42 months. The curative resection (R0) rate was 94% in cT4 group and 70% in LN invasion group. The 3-year overall survival (OS) and 3-year locoregional control (LRC) rates were 65–80% in the cT4 group and 50–67% in LN invasion group, respectively.

Conclusions

The cT4 group showed good rates of R0, OS, and LRC. Surgical resection should be an effective option when downstaging is achieved by CRT for patients with initially inoperable thoracic esophageal cancer.

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Authors and Affiliations

  1. Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Hideyuki Morimoto, Kosuke Amano, Masako Hosono & Yukio Miki

  2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan

    Yushi Fujiwara & Shigeru Lee

  3. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

    Harushi Osugi

Authors
  1. Hideyuki Morimoto
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  2. Yushi Fujiwara
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  3. Shigeru Lee
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  4. Kosuke Amano
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  5. Masako Hosono
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  6. Yukio Miki
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  7. Harushi Osugi
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Corresponding author

Correspondence to Hideyuki Morimoto.

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The authors declare that they have no conflict of interest.

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All applicable institutional and national guidelines for the care and use of animals were followed.

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Morimoto, H., Fujiwara, Y., Lee, S. et al. Treatment results of neoadjuvant chemoradiotherapy followed by radical esophagectomy in patients with initially inoperable thoracic esophageal cancer. Jpn J Radiol 36, 23–29 (2018). https://doi.org/10.1007/s11604-017-0693-0

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  • DOI: https://doi.org/10.1007/s11604-017-0693-0

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