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Using Pretreatment Tumor Depth and Length to Select Esophageal Squamous Cell Carcinoma Patients for Nonoperative Treatment After Neoadjuvant Chemoradiotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Two randomized trials have shown that in patients with good response to neoadjuvant chemoradiotherapy (nCRT), a nonoperative approach (additional CRT) had equal survival to scheduled esophagectomy. However, controversy exists because of the high locoregional recurrence (LR) following a nonoperative approach. Endoscopic complete response (e-CR) determined by endoscopic finding is a good criterion for predicting local control after definitive CRT. We evaluated whether e-CR could also be used to select patients for nonoperative treatment after nCRT.

Methods

We retrospectively analyzed esophageal squamous cell carcinoma (SCC) patients with e-CR after nCRT between 1999 and 2006. Patients were divided into two groups by the type of treatment given after e-CR (group A, scheduled esophagectomy; group B, no scheduled surgery and continued CRT).

Results

There were 71 and 79 patients in groups A and B, respectively with similar pre/post-nCRT characteristics. Despite similarity in survival and recurrence between groups, the recurrence site differed significantly. LR occurred more frequently in group B, whereas systemic recurrence was the predominant failure pattern in group A (P < .001). With use of multivariate analysis on group B, we determined that pretreatment depth of tumor invasion ≥T3 [odds ratio (OR), 11.19; 95 % CI, 1.4–89; unfavorable, P = .023] and tumor length ≥6 cm (OR, 3.069; 95 % CI, 1.17–8.1; unfavorable, P = .023) were predictors for LR. Patients with initial clinical T2 and <6 cm tumor had comparable LR (5 %) to the surgery group; these patients were candidates for nonoperative treatment after nCRT.

Conclusion

In esophageal SCC patients who achieved e-CR after nCRT, pretreatment tumor depth and length were good indicators to select candidates for nonoperative treatment.

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Acknowledgment

This study was supported in part by Grant NSC 101-2314-B-182-094-MY2 from the National Science Council, Executive Yuan, and in part by Grant NMRPD1B1431 from Chang Gung Memorial Hospital & Chang Gung university, Taiwan, Republic of China.

Conflict of interest

None of the authors have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yin-Kai Chao MD, PhD & Yun-Hen Liu MD

  2. Department of Radiation Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Chen-Kan Tseng MD

  3. Clinical Informatics and Medical Statistics Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yu-Wen Wen PhD

  4. Division of Radiology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Yung-Liang Wan MD

  5. Division of Gastroenterology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Cheng-Tung Chiu MD

  6. Division of Haematology/Oncology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Wen-Cheng Chang MD & Hsien-Kun Chang MD

Authors
  1. Yin-Kai Chao MD, PhD
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  2. Chen-Kan Tseng MD
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  3. Yu-Wen Wen PhD
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  4. Yun-Hen Liu MD
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  5. Yung-Liang Wan MD
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  6. Cheng-Tung Chiu MD
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  7. Wen-Cheng Chang MD
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  8. Hsien-Kun Chang MD
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Corresponding author

Correspondence to Hsien-Kun Chang MD.

Electronic supplementary material

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10434_2013_2962_MOESM1_ESM.doc

Disease-specific survival in group A versus group B patients after propensity-matched analysis (62 pairs). Supplementary material 1 (DOC 96 kb)

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Chao, YK., Tseng, CK., Wen, YW. et al. Using Pretreatment Tumor Depth and Length to Select Esophageal Squamous Cell Carcinoma Patients for Nonoperative Treatment After Neoadjuvant Chemoradiotherapy. Ann Surg Oncol 20, 3000–3008 (2013). https://doi.org/10.1245/s10434-013-2962-1

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  • DOI: https://doi.org/10.1245/s10434-013-2962-1

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