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Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma

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Abstract

Background

The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and recently, good clinical outcomes of this treatment have been reported. This study compared prognosis after definitive chemoradiotherapy with radical esophagectomy.

Methods

From January 2011 to December 2019, 68 consecutive patients who were diagnosed clinical T1bN0M0 squamous cell carcinoma were enrolled and investigated retrospectively. Patients were classified into two groups whether treated by surgery or definitive chemoradiotherapy. Survival outcomes were compared, and subsequent therapies after recurrence were also investigated.

Results

Among 68 patients, 39 patients underwent surgery and 29 patients received definitive chemoradiotherapy. No significant difference was noted in overall survival between the two groups. However, the rate of 5-year recurrence-free survival was significantly lower in definitive chemoradiotherapy group than that of surgery group (91.1 vs. 62.7%, hazard ratio 3.976, 95% confidence interval 1.076–14.696, p = 0.039). Patients who had local recurrence after definitive chemoradiotherapy received endoscopic submucosal dissection or photodynamic therapy as salvage therapies, which resulted in no disease progression and a good prognosis.

Conclusions

Definitive chemoradiotherapy may become a promising alternative therapy comparable with radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma. Early detection of recurrence by frequent follow-up after definitive chemoradiotherapy is important to control disease within local recurrence, and salvage therapy for local lesions could contribute to long-term survival.

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Acknowledgements

The authors thank Kohei Takizawa and Yohei Yabuuchi of Division of Endoscopy, Shizuoka Cancer Center, with respect to endoscopic diagnosis. And the authors also thank Keita Mori, Takanori Kawabata and Akifumi Nozu of Division of Clinical Research Support Center, Shizuoka Cancer Center, for assisting in statistical analysis.

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Authors and Affiliations

  1. Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan

    Ryoma Haneda, Eisuke Booka, Kenjiro Ishii & Yasuhiro Tsubosa

  2. Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan

    Ryoma Haneda, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Kinji Kamiya & Hiroya Takeuchi

  3. Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Hirofumi Ogawa

  4. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan

    Hirofumi Yasui

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  1. Ryoma Haneda
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  2. Eisuke Booka
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Corresponding author

Correspondence to Eisuke Booka.

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The authors declare that they have no conflict of interest associated with this study.

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All procedures were conducted in accordance with institutional and national standards on human experimentation, as confirmed by the Ethics Committee of Shizuoka Cancer Center, and with the Declaration of Helsinki of 1964 and its subsequent versions.

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Informed consent was obtained from all individual participants included in the study.

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Haneda, R., Booka, E., Ishii, K. et al. Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma. World J Surg 45, 1835–1844 (2021). https://doi.org/10.1007/s00268-021-06016-4

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  • DOI: https://doi.org/10.1007/s00268-021-06016-4

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