Skip to main content

Advertisement

SpringerLink
Log in

Clinical and oncological effects of triplet chemotherapy followed by radical esophagectomy for resectable esophageal cancer associated with unfavorable prognostic factors

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purposes

The purpose of this study was to evaluate the hypothesis that the survival of patients undergoing R0 resection after triplet chemotherapy for resectable esophageal cancer with unfavorable prognostic factors (Category 3) would be similar to that of patients undergoing esophagectomy for esophageal cancer without such factors (Category 1).

Methods

Patients with Category 3 tumors were assigned to receive triplet chemotherapy consisting of 5-fluorouracil, doxorubicin and nedaplatin (FAN) followed by radical esophagectomy. The outcomes of the bimodality treatment for Category 3 patients (n = 25) were compared with those of Category 1 patients (n = 41) in a prospective cohort study.

Results

Grade 3 or higher toxicity developed during chemotherapy in 32 % of the Category 3 patients, with no treatment-related deaths. No significant difference was detected in the surgery-related mortality and morbidity rates between the two groups. The recurrence-free survival was significantly worse in Category 3 than in Category 1 patients (p = 0.002), although the overall survival was not significantly different (p = 0.085) between the two groups in cases of R0 resection (5-year survival rates: 34.4 vs. 66.5 %).

Conclusions

Although FAN chemotherapy followed by radical esophagectomy can be safely performed, this treatment modality may not have sufficient power to cure Category 3 disease.

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
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Nishimaki T, Shimoji H, Sunagawa H. Recent changes and the future roles of esophageal cancer surgery. Ann Thorac Cardiovasc Surg. 2004;10:324–32.

    PubMed  Google Scholar 

  2. Nishimaki T, Suzuki T, Suzuki S, Kuwabara S, Hatakeyama K. Outcomes of extended radical esophagectomy for thoracic esophageal cancer. J Am Coll Surg. 1998;186:306–12.

    Article  CAS  PubMed  Google Scholar 

  3. Nishimaki T, Suzuki T, Tanaka Y, Aizawa K, Hatakeyama K, Muto T. Intramural metastases from esophageal cancer: local indicators of advanced disease. World J Surg. 1996;20:32–7.

    Article  CAS  PubMed  Google Scholar 

  4. Okuyama T, Korenaga D, Edagawa A, Itoh S, Oki E, Kawanaka H, et al. Prognostic effects of oral anti-cancer drugs as adjuvant chemotherapy for 2 years after gastric cancer surgery. Surg Today. 2012;42:734–40.

    Article  CAS  PubMed  Google Scholar 

  5. Sjoquist KM, Burmeister BH, Smithers BM, Zalcberg JR, Simes RJ, Barbour A, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for respectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.

    Article  PubMed  Google Scholar 

  6. Ando N, Kato H, Igawa H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  PubMed  Google Scholar 

  7. Sobin LH, Wittekind C. UICC: TNM classification of malignant tumors. 6th ed. New York: Wiley-Liss; 2002.

    Google Scholar 

  8. Nishimaki T, Tanaka O, Ando N, Ide H, Watanabe H, Shinoda M, et al. Evaluation of the accuracy of preoperative staging in thoracic esophageal cancer. Ann Thorac Surg. 1999;68:2059–64.

    Article  CAS  PubMed  Google Scholar 

  9. Kosugi S, Kanda T, Nakagawa S, Ohashi T, Nishimaki T, Hatakeyama K. Efficacy and toxicity of fluorouracil, doxorubicin, and cisplatin/nedaplatin treatment as neoadjuvant chemotherapy for advanced esophageal carcinoma. Scand J Gastroenterol. 2005;40:886–92.

    Article  CAS  PubMed  Google Scholar 

  10. Japan Esophageal Society. Japanese Classification of Esophageal Cancer. 10th ed. Tokyo: Kanehara & Co., Ltd; 2008.

  11. Komukai S, Nishimaki T, Watanabe H, Ajioka Y, Suzuki T, Hatakeyama K. Significance of immunohistochemically demonstrated micrometastases to lymph nodes in esophageal cancer with histologically negative nodes. Surgery. 2000;127:40–6.

    Article  CAS  PubMed  Google Scholar 

  12. Nishimaki T, Tanaka O, Suzuki T, Aizawa K, Hatakeyama K, Muto T. Patterns of lymphatic spread in thoracic esophageal cancer. Cancer. 1994;74:4–11.

    Article  CAS  PubMed  Google Scholar 

  13. Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med. 1998;339:1979–84.

    Article  CAS  PubMed  Google Scholar 

  14. Miyata H, Yamasaki M, Kurokawa Y, Takiguchi S, Nakajima K, Fujiwara Y, et al. Clinical relevance of induction triplet chemotherapy for esophageal cancer invading adjacent organs. J Surg Oncol. 2012;106:441–7.

    Article  PubMed  Google Scholar 

  15. Rizk NP, Ishwaran H, Rice TW, Chen LQ, Schipper PH, Kesler KA, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251:46–50.

    Article  PubMed  Google Scholar 

  16. Morgan MA, Lewis WG, Casbard A, Roberts SA, Adams R, Clark GW, et al. Stage-for-stage comparison of definitive chemoradiotherapy, surgery alone and neoadjuvant chemotherapy for oesophageal carcinoma. Br J Surg. 2009;96:1300–7.

    Article  CAS  PubMed  Google Scholar 

  17. Peyre CG, Hagen JA, DeMeester SR, Van Lanschot JJ, Hölscher A, Law S, et al. Predicting systemic disease in patients with esophageal cancer after esophagectomy: a multinational study on the significance of the number of involved lymph nodes. Ann Surg. 2008;248:979–85.

    Article  PubMed  Google Scholar 

  18. Law S, Fok M, Chow S, Chu KM, Wong J. Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg. 1997;114:210–7.

    Article  CAS  PubMed  Google Scholar 

  19. Ancona E, Ruol A, Santi S, Merigliano S, Sileni VC, Koussis H, et al. Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma. Cancer. 2001;91:2165–74.

    Article  CAS  PubMed  Google Scholar 

  20. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006;354:567–78.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

H. Shimoji and the co-authors have no conflicts of interest to declare in association with this study.

Author information

Authors and Affiliations

  1. Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan

    Hideaki Shimoji, Tatsuya Kinjo, Hiroyuki Karimata, Masayoshi Nagahama & Tadashi Nishimaki

Authors
  1. Hideaki Shimoji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatsuya Kinjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroyuki Karimata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Masayoshi Nagahama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tadashi Nishimaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideaki Shimoji.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimoji, H., Kinjo, T., Karimata, H. et al. Clinical and oncological effects of triplet chemotherapy followed by radical esophagectomy for resectable esophageal cancer associated with unfavorable prognostic factors. Surg Today 44, 1273–1281 (2014). https://doi.org/10.1007/s00595-013-0700-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0700-8

Keywords

Search

Navigation