Abstract
The need for surgery after chemoradiotherapy for a T4N0-1M0 squamous cell carcinoma in the thoracic esophagus was evaluated. A series of 53 patients were enrolled in this prospective nonrandomized trial from among 124 patients with an esophageal cancer assessed as T4 in Kurume University Hospital from 1994 to 2002. After the first chemoradiotherapy cycle, which consisted of radiotherapy in a total dosage of 36 Gy and chemotherapy using cisplatin (CDDP) and 5-fluorouracil (5FU), the patients each decided, after being informed of the efficacy of the chemoradiotherapy, whether to undergo surgery. All patients, including those who had undergone surgery and those who had not, later underwent a second chemoradiotherapy cycle consisting of radiotherapy in a total dosage of 24 Gy and chemotherapy using CDDP and 5FU, as far as practicable. Among the responders to the first chemoradiotherapy cycle, there was no significant difference in the long-term (5-year) survival rate between the 18 patients who underwent esophageal surgery and the 13 patients who did not (23% vs. 23%). Among the nonresponders, the 11 patients who underwent surgery showed a tendency toward longer survival than the five patients who had had no surgery. The nonresponders had 1- and 2-year survival rates of 64% and 33%, respectively. The corresponding rates for the 5 nonsurgical patients who completed the two chemoradiotherapy cycle were 20% ands 20%, respectively. For a T4N0-1M0 squamous cell carcinoma in the thoracic esophagus, full-dosage chemoradiotherapy (definitive chemoradiotherapy) is preferred for responders to a half-dose of chemoradiotherapy as much as esophagectomy, whereas esophagectomy may be preferred for nonresponders.
Similar content being viewed by others
References
Y Ichiyoshi H Kawahara S Taga et al. (1999) ArticleTitleIndications and operative techniques for combined aortoesophageal resection Jpn. J. Thorac. Cardiovasc. Surg. 47 318–324
H Fujita T Kakegawa H Kawahara et al. (1992) ArticleTitleQuestionable resection for carcinoma of the esophagus involving the trachea, bronchus and/or aorta-a comparative and multivariate analysis Kurume Med. J. 39 183–189
M Stahl H Wilke U Fink et al. (1996) ArticleTitleCombined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer: interim analysis of a phase II trial J. Clin. Oncol. 14 829–837
D Raemdonck ParticleVan E Cutsem Particlevan J Menten et al. (1997) ArticleTitleInduction therapy for clinical T4 oesophageal carcinoma: a plea for continued surgical exploration Eur. J. Cardiovasc. Surg. 11 828–837
M Yano T Tsujinaka H Shiozaki et al. (1999) ArticleTitleConcurrent chemotherapy (5-fluorouracil and cisplatin) and radiation therapy followed by surgery for T4 squamous cell carcinoma of the esophagus J. Surg. Oncol. 70 25–32
LE Harrison (2000) ArticleTitleIs esophageal cancer a surgical disease? J Surg. Oncol. 75 227–231
A Ohtsu N Boku K Muro et al. (1999) ArticleTitleDefinitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus J. Clin. Oncol. 17 2915–2921
JD Urschel S Ashiku R Thurer et al. (2003) ArticleTitleSalvage or planned esophagectomy after chemoradiation therapy for locally advanced esophageal cancer: a review Dis. Esophagus 16 60–65
International Union Against Cancer (2002) In: Sobin, LH, Wittekind, CH (editors), TNM Classification of Malignant Tumours, 6, Wiley-Liss, New york, pp 1–18; pp 60–64
H Fujita S Sueyoshi T Tanaka et al. (2003) ArticleTitleOptimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: comparing the short- and long-term outcome among the four types of lymphadenectomy World J. Surg. 27 571–579
InstitutionalAuthorNameJapanese Society for Esophageal Diseases (2001) Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus EditionNumber9 Kanehara Tokyo 63–83
P Therasse SG Arbuck EA Eisenhauer et al. (2000) ArticleTitleNew guidelines to evaluate the response to treatment in solid tumors J. Natl. Cancer Inst. 92 205–216
A Trotti R Byhardt J Stetz et al. (2000) ArticleTitleCommon toxicity criteria: version 2.0, an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy Int. J. Radiat. Oncol. Phys. 47 13–47
L Bedenne P Michel O Bouche et al. (2002) ArticleTitleRandomized phase III trial in locally advanced esophageal cancer: radiochemotherapy followed by surgery versus radiochemotherapy alone (FFCD 9102) [abstract] Proc. Am. Soc. Clin. Oncol. 21 130
M Stahl H Wilke MK Walz et al. (2003) ArticleTitleRandomized phase III trial in locally-advanced squamous cell carcinoma (SCC) of the esophagus: chemoradiation with and without surgery [abstract] Proc. Am. Soc. Clin. Oncol. 22 250
M Murakami Y Kuroda S Matsusue et al. (2000) ArticleTitleTreatment results of esophageal carcinoma of clinical T3T4, M0: historical comparison between neoadjuvant chemoradiotherapy followed by surgery or definitive radiotherapy and conventional surgery Oncol. Rep. 7 571–578
C Hennequin B Gayet A Sauvanet et al. (2001) ArticleTitleImpact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus Int. J. Radiat. Oncol. Biol. Phys. 49 657–664
Acknowledgments
This work was supported by the Japan Society for the Promotion of Science (JSPS), a Grant-in-Aid for Scientific Research (C).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Fujita, H., Sueyoshi, S., Tanaka, T. et al. Esophagectomy: Is It Necessary after Chemoradiotherapy for a Locally Advanced T4 Esophageal Cancer? Prospective Nonrandomized Trial Comparing Chemoradiotherapy with Surgery versus without Surgery. World J. Surg. 29, 25–31 (2005). https://doi.org/10.1007/s00268-004-7590-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-004-7590-2