Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 9, pp 2747–2755 | Cite as

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

  • Michele Valmasoni
  • Elisa Sefora Pierobon
  • Gianpietro Zanchettin
  • Dario Briscolini
  • Lucia Moletta
  • Alberto Ruol
  • Renato Salvador
  • Stefano Merigliano
Gastrointestinal Oncology
  • 206 Downloads

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.

Notes

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.

References

  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.CrossRefPubMedGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 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.PubMedPubMedCentralGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.CrossRefGoogle Scholar
  16. 16.
    Associazione Italiana Radioterapia Oncologica. La Radioterapia dei Tumori Gastrointestinali; 2014. p. 1–149.Google Scholar
  17. 17.
    WHO-toxicity scale. In: Nahler G. Dictionary of pharmaceutical medicine. Vienna: Springer; 2009. p. 194.Google Scholar
  18. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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. 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.CrossRefPubMedGoogle Scholar
  21. 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. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.CrossRefPubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar
  29. 29.
    Gourin CG, Terris DJ. Carcinoma of the hypopharynx. Surg Oncol Clin N Am. 2004;13(1):81–98.CrossRefPubMedGoogle Scholar
  30. 30.
    Mariette C, Triboulet JP. Which treatment for squamous cell carcinoma of the pharyngoesophageal junction? J Surg Oncol. 2006;94(3):175–7.CrossRefPubMedGoogle Scholar
  31. 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.PubMedPubMedCentralGoogle Scholar
  32. 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.Google Scholar
  33. 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.CrossRefPubMedGoogle Scholar
  34. 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.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Condon HA. Anaesthesia for pharyngo-laryngo-oesophagectomy with pharyngo-gastrostomy. Br J Anaesth. 1971;43(11):1061–4.CrossRefPubMedGoogle Scholar
  36. 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.CrossRefPubMedGoogle Scholar
  37. 37.
    Wei WI, Lam LK, Yuen PW, Wong J. Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis. Head Neck. 1998;20(3):240–4.CrossRefPubMedGoogle Scholar
  38. 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.CrossRefPubMedGoogle Scholar
  39. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 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.CrossRefPubMedGoogle Scholar
  41. 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.CrossRefPubMedGoogle Scholar
  42. 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.CrossRefPubMedGoogle Scholar
  43. 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.CrossRefPubMedGoogle Scholar
  44. 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.CrossRefGoogle Scholar
  45. 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.CrossRefGoogle Scholar
  46. 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.CrossRefPubMedGoogle Scholar
  47. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal DiseaseUniversity of PadovaPaduaItaly
  2. 2.University HospitalPaduaItaly

Personalised recommendations