Skip to main content
SpringerLink
Log in

Cervical Esophageal Cancer Treatment Strategies: A Cohort Study Appraising the Debated Role of Surgery

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

Abstract

Background

Few studies have examined optimal treatment specifically for cervical esophageal carcinoma. This study evaluated the outcome of three common treatment strategies with a focus on the debated role of surgery.

Methods

All patients with cervical esophageal cancer treated at a single center were identified and their outcomes analyzed in terms of morbidity, mortality, and recurrence according to the treatment they received, i.e. surgery alone, definitive platinum-based chemoradiation (CRT), or CRT followed by surgery.

Results

The study population included 148 patients with cervical esophageal cancer from a prospective database of 3445 patients. Primary surgery was the treatment of choice for 56 (37.83%) patients, definitive CRT was the treatment of choice for 52 (35.13%) patients, and CRT followed by surgery was the treatment of choice for 40 (27.02%) patients. CRT-treated patients obtained 36.96% complete clinical response, with overall morbidity and mortality rates of 36.95 and 2.17%, respectively. Surgical complete resection was achieved in 71.88% of surgically treated cases, with morbidity and mortality rates of 52.17 and 6.25%, respectively. No significant survival difference existed among the three treatments, but patients who underwent surgery alone had a significantly lower stage of disease (p = 0.031). Compared with patients with complete response after CRT, surgery did not confer any significant survival benefit, and overall 5-year survival was lower than definitive CRT alone. In contrast, surgery improved survival significantly in patients with non-complete response after definitive CRT (p = 0.023).

Conclusions

Definitive platinum-based CRT should be the treatment of choice for cervical esophageal cancer. Surgery has a role for patients with non-complete response as it adds significant survival benefit, with acceptable morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lee D-J, Harris A, Gillette A, Munoz L, Kashima H. Carcinoma of the cervical esophagus: diagnosis, management, and results. South Med J. 1984;77(11):1365–7.

    Article  PubMed  CAS  Google Scholar 

  2. Grass GD, Cooper SL, Armeson K, Garrett-Mayer E, Sharma A. Cervical esophageal cancer: a population-based study. Head Neck. 2015;37(6):808–14.

    Article  PubMed  Google Scholar 

  3. Ajani JA, D’Amico TA, Almhanna K, et al. Esophageal and esophagogastric junction cancers, version 1.2015. J Natl Compr Cancer Netw. 2015;13(2):194–227.

    Article  CAS  Google Scholar 

  4. Lordick F, Mariette C, Haustermans K, Obermannova R, Arnold D, Comm EG. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(Suppl 5):v50–7.

    Article  PubMed  CAS  Google Scholar 

  5. Conroy T, Galais M-P, Raoul J-L, et al. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol. 2014;15(3):305–14.

    Article  PubMed  CAS  Google Scholar 

  6. Sun F, Li X, Lei D, et al. Surgical management of cervical esophageal carcinoma with larynx preservation and reconstruction. Int J Clin Exp Med. 2014;7(9):2771–8.

    PubMed  PubMed Central  Google Scholar 

  7. Gkika E, Gauler T, Eberhardt W, Stahl M, Stuschke M, Poettgen C. Long-term results of definitive radiochemotherapy in locally advanced cancers of the cervical esophagus. Dis Esophagus. 2014;27(7):678–84.

    Article  PubMed  CAS  Google Scholar 

  8. Alonso Garcia A, Querejeta Recalde A, Alonso Pantiga R, Martinez-Camblor P, Alonso Sanchez D. Results of curative treatment in cervical carcinoma. Rep Pract Oncol Radiother. 2013;18:S227.

    Article  Google Scholar 

  9. Schieman C, Wigle DA, Deschamps C, et al. Salvage resections for recurrent or persistent cancer of the proximal esophagus after chemoradiotherapy. Ann Thorac Surg. 2013;95(2):459–64.

    Article  PubMed  Google Scholar 

  10. Poettgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer: a meta-analysis of the randomized trials. Cancer Treat Rev. 2012;38(6):599–604.

    Article  Google Scholar 

  11. Esteller E, Vega MC, López M, Quer M, León X. Salvage surgery after locoregional failure in head and neck carcinoma patients treated with chemoradiotherapy. Eur Arch Otorhinolaryngol. 2011;268(2):295–301.

    Article  PubMed  CAS  Google Scholar 

  12. Uno T, Isobe K, Kawakami H, et al. Concurrent chemoradiation for patients with squamous cell carcinoma of the cervical esophagus. Dis Esophagus. 2007;20(1):12–8.

    Article  PubMed  CAS  Google Scholar 

  13. Yamada K, Murakami M, Okamoto Y, et al. Treatment results of radiotherapy for carcinoma of the cervical esophagus. Acta Oncol. 2006;45(8):1120–25.

    Article  PubMed  Google Scholar 

  14. Hu G, Wei L, Zhu J, Zhou J. Surgical management of carcinoma of the hypopharynx and cervical esophagus. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2004;18(6):329–31.

    PubMed  Google Scholar 

  15. Rice TW. 7th edition AJCC/UICC staging: esophagus and esophagogastric junction. In: Giacopuzzi S, Zanoni A, de Manzoni G, editors. Adenocarcinoma of the esophagogastric junction. Cham: Springer; 2017. p. 41–6.

    Chapter  Google Scholar 

  16. Associazione Italiana Radioterapia Oncologica. La Radioterapia dei Tumori Gastrointestinali; 2014. p. 1–149.

  17. WHO-toxicity scale. In: Nahler G. Dictionary of pharmaceutical medicine. Vienna: Springer; 2009. p. 194.

  18. Schwartz LH, Litiere S, de Vries E, et al. RECIST 1.1-update and clarification: from the RECIST committee. Eur J Cancer. 2016;62:132–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Dindo D. The Clavien–Dindo classification of surgical complications. In: Cuesta MA, Bonjer HJ, editors. Treatment of postoperative complications after digestive surgery. London: Springer; 2013. p. 13–7.

    Google Scholar 

  20. In H, Palis BE, Merkow RP, et al. Doubling of 30-day mortality by 90 days after esophagectomy: a critical measure of outcomes for quality improvement. Ann Surg. 2016;263(2):286–91.

    Article  PubMed  Google Scholar 

  21. Abdi H. Bonferroni and Šidák corrections for multiple comparisons. In: Salkind N, editors. Encyclopedia of measurement and statistics. Thousand Oaks, CA: Sage Publications, Inc.; 2007.

    Google Scholar 

  22. Ghali WA, Quan H, Brant R, et al. Comparison of 2 methods for calculating adjusted survival curves from proportional hazards models. JAMA. 2001;286(12):1494–7.

    Article  PubMed  CAS  Google Scholar 

  23. Huang SH, Lockwood G, Math M, et al. Effect of concurrent high-dose cisplatin chemotherapy and conformal radiotherapy on cervical esophageal cancer survival. Int J Radiat Oncol Biol Phys. 2008;71(3):735–40.

    Article  PubMed  CAS  Google Scholar 

  24. Ludmir EB, Palta M, Wu Y, Willett CG, Czito BG. Definitive chemoradiation therapy for cervical esophageal carcinoma: a single-institution experience. Int J Radiat Oncol Biol Phys. 2014;90(1):S348.

    Article  Google Scholar 

  25. Zhang P, Xi M, Zhao L, et al. Clinical efficacy and failure pattern in patients with cervical esophageal cancer treated with definitive chemoradiotherapy. Radiother Oncol. 2015;116(2):257–61.

    Article  PubMed  Google Scholar 

  26. Hoeben A, Polak J, Van De Voorde L, Hoebers F, Grabsch HI, de Vos-Geelen J. Cervical esophageal cancer: a gap in cancer knowledge. Ann Oncol. 2016;27(9):1664–74.

    Article  PubMed  CAS  Google Scholar 

  27. Peracchia A, Bardini R, Ruol A, et al. Surgical-management of carcinoma of the hypopharynx and cervical esophagus. Hepatogastroenterology. 1990;37(4):371–5.

    PubMed  CAS  Google Scholar 

  28. Triboulet J-P, Mariette C, Chevalier D, Amrouni H. Surgical management of carcinoma of the hypopharynx and cervical esophagus: analysis of 209 cases. Arch Surg. 2001;136(10):1164–70.

    Article  PubMed  CAS  Google Scholar 

  29. Gourin CG, Terris DJ. Carcinoma of the hypopharynx. Surg Oncol Clin N Am. 2004;13(1):81–98.

    Article  PubMed  Google Scholar 

  30. Mariette C, Triboulet JP. Which treatment for squamous cell carcinoma of the pharyngoesophageal junction? J Surg Oncol. 2006;94(3):175–7.

    Article  PubMed  CAS  Google Scholar 

  31. Popescu CR, Bertesteanu SVG, Mirea D, Grigore R, Ionescu D, Popescu B. The epidemiology of hypopharynx and cervical esophagus cancer. J Med Life. 2010;3(4):396–401.

    PubMed  PubMed Central  CAS  Google Scholar 

  32. Popescu B, Popescu CR, Grigore R, et al. Morphology and morphopathology of hypopharyngo-esophageal cancer. Romanian J Morphol Embryol. 2012;53(2):243–8.

    CAS  Google Scholar 

  33. Grass GD, Cooper SL, Armeson K, Garrett-Mayer E, Sharma A. Cervical esophageal cancer: a population-based study. Head Neck. 2015;37(6):808–14.

    Article  PubMed  Google Scholar 

  34. Zhao L, Zhou Y, Mu Y, et al. Patterns of failure and clinical outcomes of definitive radiotherapy for cervical esophageal cancer. Oncotarget. 2017;8(13):21852–60.

    PubMed  PubMed Central  Google Scholar 

  35. Condon HA. Anaesthesia for pharyngo-laryngo-oesophagectomy with pharyngo-gastrostomy. Br J Anaesth. 1971;43(11):1061–4.

    Article  PubMed  CAS  Google Scholar 

  36. Haguenauer J-P, Pignat J-C. Total pharyngo-laryngo-esophagectomy and reconstruction by gastric or colic pull up. Auris Nasus Larynx. 1985;12:S41–3.

    Article  PubMed  Google Scholar 

  37. Wei WI, Lam LK, Yuen PW, Wong J. Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis. Head Neck. 1998;20(3):240–4.

    Article  PubMed  CAS  Google Scholar 

  38. Ullah R, Bailie N, Kinsella J, Anikin V, Primrose WJ, Brooker DS. Pharyngo-laryngo-oesophagectomy and gastric pull-up for post-cricoid and cervical oesophageal squamous cell carcinoma. J Laryngol Otol. 2002;116(10):826–30.

    Article  PubMed  CAS  Google Scholar 

  39. Sreehariprasad AV, Krishnappa R, Chikaraddi BS, Veerendrakumar K. Gastric pull up reconstruction after pharyngo laryngo esophagectomy for advanced hypopharyngeal cancer. Indian J Surg Oncol. 2012;3(1):4–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer—long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA. 1999;281(17):1623–7.

    Article  PubMed  CAS  Google Scholar 

  41. Pottgen C, Stuschke M. Radiotherapy versus surgery within multimodality protocols for esophageal cancer: a meta-analysis of the randomized trials. Cancer Treat Rev. 2012;38(6):599–604.

    Article  PubMed  Google Scholar 

  42. Wang S, Liao Z, Chen Y, et al. Esophageal cancer located at the neck and upper thorax treated with concurrent chemoradiation: a single-institution experience. J Thorac Oncol. 2006;1(3):252–9.

    Article  PubMed  Google Scholar 

  43. Burmeister BH, Dickie G, Smithers BM, Hodge R, Morton K. Thirty-four patients with carcinoma of the cervical esophagus treated with chemoradiation therapy. Arch Otolaryngol Head Neck Surg. 2000;126(2):205–8.

    Article  PubMed  CAS  Google Scholar 

  44. Ito M, Koide Y, Yoshida M, et al. Clinical results of definitive chemoradiation therapy for cervical esophageal cancer: comparison of failure pattern and toxicities between intensity modulated radiation therapy and 3-dimensional chemoradiation therapy group. Int J Radiat Oncol Biol Phys. 2016;96(2S):E145–6.

    Article  Google Scholar 

  45. Zhou YC, Zhao LN, Zang J, Shi M. Effects of modern technique in definitive radiation therapy for cervical esophageal cancer. Int J Radiat Oncol Biol Phys. 2016;96(2S):E191.

    Article  Google Scholar 

  46. Aoyama N, Koizumi H, Minamide J, Yoneyama K, Isono K. Prognosis of patients with advanced carcinoma of the esophagus with complete response to chemotherapy and/or radiation therapy: a questionnaire survey in Japan. Int J Clin Oncol. 2001;6(3):132–7.

    Article  PubMed  CAS  Google Scholar 

  47. Swisher SG, Wynn P, Putnam JB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg. 2002;123:175–83.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, Padua, Italy

    Michele Valmasoni MD, PhD, Elisa Sefora Pierobon MD, Gianpietro Zanchettin MD, PhD, Dario Briscolini PhD, Lucia Moletta MD, Alberto Ruol MD, Renato Salvador MD & Stefano Merigliano MD

  2. University Hospital, Padua, Italy

    Michele Valmasoni MD, PhD, Lucia Moletta MD, Renato Salvador MD & Stefano Merigliano MD

Authors
  1. Michele Valmasoni MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elisa Sefora Pierobon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianpietro Zanchettin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dario Briscolini PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lucia Moletta MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Ruol MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Renato Salvador MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefano Merigliano MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Valmasoni MD, PhD.

Ethics declarations

Disclosure

Michele Valmasoni, Elisa Sefora Pierobon, Gianpietro Zanchettin, Dario Briscolini, Lucia Moletta, Alberto Ruol, Renato Salvador, and Stefano Merigliano have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Valmasoni, M., Pierobon, E.S., Zanchettin, G. et al. Cervical Esophageal Cancer Treatment Strategies: A Cohort Study Appraising the Debated Role of Surgery. Ann Surg Oncol 25, 2747–2755 (2018). https://doi.org/10.1245/s10434-018-6648-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6648-6

Keywords

Search

Navigation