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Complete Clinical Response After Neoadjuvant Chemoradiotherapy for Squamous Cell Cancer of the Thoracic Oesophagus: Is Surgery Always Necessary?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Neoadjuvant chemoradiotherapy (CT-RT) before oesophagectomy is standard management for squamous cell carcinoma (SCC) of the thoracic oesophagus. The aim of this study was to compare the outcome of patients who had clinical complete response (CR) with neoadjuvant CT-RT + oesophagectomy with the survival of patients who had clinical CR and were not operated on.

Patients and Methods

Seventy-seven consecutive patients with SCC of the thoracic oesophagus with CR with neoadjuvant CT-RT presenting at the Regional Center of Esophageal Diseases from 1992 to 2008 were included in this retrospective study on a prospectively collected database. Thirty-nine patients underwent oesophagectomy (CT-RT + oesophagectomy), while 38 (CT-RT) were not operated on because they were considered unfit for surgery or refused the operation. Patients’ outcome and survival were compared.

Results

In the CT-RT + oesophagectomy group, clinical CR was confirmed after histological examination of the surgical specimen in 27/39 (69.2 %) patients. Five-year overall survival rates were 50.0 % in the CT-RT + oesophagectomy group and 57.0 % in the CT-RT group (p = 0.99); 5-year disease-free survival rates were 55.5 % in the CT-RT + oesophagectomy group and 34.6 % in the CT-RT group (p = 0.15). Even after adjusting for propensity score, age, ASA and clinical stage, the treatment regimen did not show a statistically significant effect on overall survival (adjusted p = 0.65) nor on disease-free survival (adjusted p = 0.15).

Conclusion

In our group of patients with clinical CR after neoadjuvant CT-RT for SCC of the thoracic oesophagus, waiting for recurrence and then using salvage surgery did not negatively impact their survival compared to patients treated with surgery. More accurate restaging protocols are warranted to improve decision making after CR with neoadjuvant CT-RT.

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Conflict of interest

This study was partially funded by the Current Research Funds of IOV. Preliminary data from this study were presented as a poster at Digestive Disease Week 2011, held between May 7 and May 10, 2011 in Chicago, IL, USA.

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Authors and Affiliations

  1. Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy

    Carlo Castoro, Marco Scarpa, Matteo Cagol, Rita Alfieri, Francesco Cavallin, Silvia Michieletto & Ermanno Ancona

  2. Department of Surgical and Gastroenterological Sciences, University of Padova, Padua, Italy

    Alberto Ruol, Giampietro Zanchettin & Ermanno Ancona

  3. Medical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy

    Vanna Chiarion-Sileni

  4. Radiation Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy

    Luigi Corti

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  1. Carlo Castoro
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  3. Matteo Cagol
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Correspondence to Marco Scarpa.

Additional information

Carlo Castoro and Marco Scarpa contributed equally to this study.

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Castoro, C., Scarpa, M., Cagol, M. et al. Complete Clinical Response After Neoadjuvant Chemoradiotherapy for Squamous Cell Cancer of the Thoracic Oesophagus: Is Surgery Always Necessary?. J Gastrointest Surg 17, 1375–1381 (2013). https://doi.org/10.1007/s11605-013-2269-3

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  • DOI: https://doi.org/10.1007/s11605-013-2269-3

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