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Evaluation of Neoadjuvant Chemoradiotherapy Followed by Surgery for Borderline Resectable Esophageal Squamous Cell Carcinoma

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Abstract

Background

It is occasionally difficult to diagnose cT3 or cT4b using imaging examinations for esophageal cancer. The optimal treatment strategy for borderline resectable esophageal squamous cell carcinoma (BR-ESCC) is unclear.

Methods

We included 131 patients with cT3 ESCC who received neoadjuvant chemoradiotherapy (NCRT) followed by surgery. The patients were classified as having definitive cT3 (D-cT3) or borderline resectable cT3 (BR-cT3), based on presence of undeniable adjacent organ invasion on pretreatment CT. Surgical outcomes and prognoses were compared among patients with D-cT3 and BR-cT3 tumors, and the risk factors for non-R0 resection were assessed.

Results

Ninety and 41 patients were classified as D-cT3 and BR-cT3, respectively. Although BR-cT3 had a significantly higher non-R0 resection rate than D-cT3 (D-cT3 3.7%; BR-cT3 14.6%), BR-cT3 was not correlated with shorter overall survival (OS) (D-cT3 5-year OS, 50.8%; BR-cT3 5-year OS 38.4%; p = 0.234). Conversely, non-R0 resection was significantly associated with poor OS (R0 resection 5-year OS 48.8%; non-R0 resection 5-year OS 22.2%; p = 0.031). Cox regression analysis of OS demonstrated that BR-cT3 was not a prognostic factor. In the analysis of risk factors for non-R0 resection, BR-cT3 (p = 0.027), suspected invasion of the trachea or bronchus (p = 0.046), and high SUVmax of the primary lesion after NCRT (p = 0.002) were risk factors.

Conclusions

NCRT followed by surgery achieved a relatively high R0 resection rate and an almost equal overall survival rate for BR-cT3 compared with D-cT3 ESCC. Thus, NCRT followed by surgery is an effective treatment strategy for patients with BR-cT3 ESCC.

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Acknowledgements

We would like to thank all the individuals of the Department of Surgical Oncology, Hiroshima University, for advice on preparing this manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgical Oncology, Hiroshima University, 1–2–3 Kasumi, Minami-Ku, Hiroshima, 734–8551, Japan

    Ryosuke Hirohata, Yoichi Hamai, Jun Hihara, Manabu Emi, Tomoaki Kurokawa, Toru Yoshikawa, Manato Ohsawa, Nao Kitasaki & Morihito Okada

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  1. Ryosuke Hirohata
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  2. Yoichi Hamai
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  3. Jun Hihara
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  4. Manabu Emi
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  5. Tomoaki Kurokawa
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  7. Manato Ohsawa
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Correspondence to Yoichi Hamai.

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

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This study was approved by the Institutional Review Board of Hiroshima University (Ethical Committee for Epidemiology of Hiroshima University, E-2225).

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Hirohata, R., Hamai, Y., Hihara, J. et al. Evaluation of Neoadjuvant Chemoradiotherapy Followed by Surgery for Borderline Resectable Esophageal Squamous Cell Carcinoma. World J Surg 46, 1934–1943 (2022). https://doi.org/10.1007/s00268-022-06568-z

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