Skip to main content
SpringerLink
Log in

Is the Outcome of a Salvage Surgery for T4 Thoracic Esophageal Squamous Cell Carcinoma Really Poor?

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Among patients with T4 thoracic esophageal squamous cell carcinoma (TESCC), it is unclear whether the outcomes of late responders who undergo high-dose chemoradiotherapy (CRT) followed by salvage esophagectomy differs from those of early responders who undergo low-dose CRT followed by esophagectomy.

Methods

A total of 153 patients with T4 TESCC were treated with CRT. The first evaluation was performed after 40 Gy of CRT for downstaging. Of these, 28 patients could be downstaged, and underwent subsequent surgery (early responders). For the remaining patients, additional CRT was administered, and patients were re-evaluated after treatment and underwent salvage surgery. In total, 40 patients (early + late responders) were analyzed.

Results

The primary tumors exhibited a grade 3 response in six (21.4 %) of the early responders and two (16.7 %) of the late responders (p = 1.000). The rate of residual tumor in the primary tumor was 80 % (32/40 patients). The proportions of resected lymph nodes and positive metastatic nodes were similar between early and late responders (p = 0.406 and p = 0.859, respectively). The 5-year overall survival rates among the early and late responders were 25.9 and 36.5 %, respectively, and the median survival times were 24.8 and 24.3 months (p = 0.925), respectively. The 5-year cause-specific survival rates in the early and late responder groups were 61.5 and 72.9 % (p = 0.425), respectively.

Conclusion

The outcomes of both early and late responders to CRT were similar, and salvage surgery for T4 TESCC outweighs the risks in patients with T4 TESCC.

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. Ozawa S, Tachimori Y, Baba H et al (2012) Comprehensive registry of esophageal cancer in Japan, 2004. Esophagus 9:75–98

    Article  Google Scholar 

  2. Akutsu Y, Uesato M, Shuto K et al (2013) The overall prevalence of metastasis in T1 esophageal squamous cell carcinoma: a retrospective analysis of 295 Patients. Ann Surg 257(6):102–108

    Article  Google Scholar 

  3. Griffin SM, Burt AD, Jennings NA (2011) Lymph node metastasis in early esophageal adenocarcinoma. Ann Surg 254:731–736 discussion 736–737

    Article  PubMed  CAS  Google Scholar 

  4. Shimada H, Shiratori T, Okazumi S et al (2008) Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45 years of experience. J Am Coll Surg 206:48–56

    Article  PubMed  Google Scholar 

  5. Nabeya Y, Ochiai T, Matsubara H et al (2005) Neoadjuvant chemoradiotherapy followed by esophagectomy for initially resectable squamous cell carcinoma of the esophagus with multiple lymph node metastasis. Dis Esophagus 18(6):388–397

    Article  PubMed  Google Scholar 

  6. Miyoshi N, Yano M, Takachi K et al (2009) Myelotoxicity of preoperative chemoradiotherapy is a significant determinant of poor prognosis in patients with T4 esophageal cancer. J Surg Oncol 99:302–306

    Article  PubMed  CAS  Google Scholar 

  7. de Manzoni G, Pedrazzani C, Pasini F et al (2007) Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol 95:261–266

    Article  PubMed  Google Scholar 

  8. Seto Y, Chin K, Gomi K et al (2007) Treatment of thoracic esophageal carcinoma invading adjacent structures. Cancer Sci 98:937–942

    Article  PubMed  CAS  Google Scholar 

  9. Akutsu Y, Matsubara H, Shuto K et al (2009) Clinical and pathologic evaluation of the effectiveness of neoadjuvant chemoradiation therapy in advanced esophageal cancer patients. World J Surg 33:1002–1009. doi:10.1007/s00268-008-9899-8

    Article  PubMed  Google Scholar 

  10. Shimoji H, Karimata H, Nagahama M et al (2013) Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: results of a prospective cohort study. World J Surg 37(9):2180–2188. doi:10.1007/s00268-013-2074-x

    Article  PubMed  Google Scholar 

  11. Tachibana M, Dhar DK, Kinugasa S et al (2002) Surgical treatment for locally advanced (T4) squamous cell carcinoma of the thoracic esophagus. Dysphagia 17:255–261

    Article  PubMed  Google Scholar 

  12. Miyata H, Yamasaki M, Takiguchi S et al (2009) Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol 100:442–446

    Article  PubMed  CAS  Google Scholar 

  13. Minsky BD, Pajak TF, Ginsberg RJ et al (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174

    Article  PubMed  CAS  Google Scholar 

  14. Cooper JS, Guo MD, Herskovic A et al (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA 281:1623–1627

    Article  PubMed  CAS  Google Scholar 

  15. Aoyagi T, Shuto K, Okazumi S et al (2010) Evaluation of the clinical staging of esophageal cancer by using diffusion-weighted imaging. Exp Ther Med 1:847–851

    Google Scholar 

  16. Takubo K, Makuuchi H, Fujita H et al (2009) Japanese classification of esophageal cancer, tenth edition: part I. Esophagus 6:1–25

    Article  Google Scholar 

  17. Takubo K, Makuuchi H, Fujita H et al (2009) Japanese classification of esophageal cancer, tenth edition: parts II and III. Esophagus 6:71–94

    Article  Google Scholar 

  18. Markar SR, Karthikesalingam A, Penna M et al (2014) Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol 21(3):922–931

    Article  PubMed  Google Scholar 

  19. Murphy CC, Correa AM, Ajani JA et al (2013) Surgery is an essential component of multimodality therapy for patients with locally advanced esophageal adenocarcinoma. J Gastrointest Surg 17(8):1359–1369

    Article  PubMed  Google Scholar 

  20. Piessen G, Messager M, Mirabel X et al (2013) Is there a role for surgery for patients with a complete clinical response after chemoradiation for esophageal cancer? An intention-to-treat case-control study. Ann Surg 258:793–800

    Article  PubMed  Google Scholar 

  21. Makino T, Doki Y (2011) Treatment of T4 esophageal cancer. Definitive chemo-radiotherapy vs chemo-radiotherapy followed by surgery. Ann Thorac Cardiovasc Surg 17(3):221–228

    Article  PubMed  Google Scholar 

  22. Fujita H, Sueyoshi S, Tanaka T et al (2005) 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 29:25–30. doi:10.1007/s00268-004-7590-2 discussion 30–31

    Article  PubMed  Google Scholar 

  23. Welsh J, Settle SH, Amini A et al (2012) Failure patterns in patients with esophageal cancer treated with definitive chemoradiation. Cancer 118:2632–2640

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shimada H, Okazumi S, Matsubara H et al (2006) Impact of the number and extent of positive lymph nodes in 200 patients with thoracic esophageal squamous cell carcinoma after three-field lymph node dissection. World J Surg 30:1441–1449. doi:10.1007/s00268-005-0462-6

    Article  PubMed  Google Scholar 

  25. Akutsu Y, Shuto K, Kono T et al (2012) The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma. J Surg Oncol 105:756–760

    Article  PubMed  Google Scholar 

  26. Akutsu Y, Matsubara H (2013) Lymph node dissection for esophageal cancer. Gen Thorac Cardiovasc Surg 61(7):397–401

    Article  PubMed  Google Scholar 

  27. Crosby TD, Brewster AE, Borley A et al (2004) Definitive chemoradiation in patients with inoperable oesophageal carcinoma. Br J Cancer 90:70–75

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest that should be disclosed.

Author information

Authors and Affiliations

  1. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan

    Yasunori Akutsu, Tsuguaki Kono, Masaya Uesato, Isamu Hoshino, Kentaro Murakami, Tomoyoshi Aoyagi, Takumi Ota, Takeshi Toyozumi, Hiroshi Suito & Hisahiro Matsubara

  2. Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan

    Hiroki Kobayashi, Rintaro Harada & Takashi Uno

Authors
  1. Yasunori Akutsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsuguaki Kono
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masaya Uesato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isamu Hoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kentaro Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomoyoshi Aoyagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takumi Ota
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeshi Toyozumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroshi Suito
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroki Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rintaro Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Takashi Uno
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Hisahiro Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasunori Akutsu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Akutsu, Y., Kono, T., Uesato, M. et al. Is the Outcome of a Salvage Surgery for T4 Thoracic Esophageal Squamous Cell Carcinoma Really Poor?. World J Surg 38, 2891–2897 (2014). https://doi.org/10.1007/s00268-014-2668-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-014-2668-y

Keywords

Search

Navigation