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Long-term outcomes of multimodal therapy combining definitive chemoradiotherapy and salvage surgery for T4 esophageal squamous cell carcinoma

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Abstract

Background

Survival outcomes of patients with cT4 esophageal squamous cell carcinoma (ESCC) remain extremely poor. We aimed to investigate long-term outcomes and identify prognostic factors in patients treated by definitive chemoradiotherapy (dCRT) alone or with dCRT plus salvage surgery (SALV) for cT4 ESCC.

Patients and methods

In total, 73 patients completing dCRT were analyzed. Patients achieving clinical complete response (CR) received follow-up evaluations thereafter. For patients diagnosed with clinical partial response (PR), potentially curative SALV was generally performed. Possible prognostic factors included demographic data, tumor staging, blood chemistry profiles, and esophageal stenosis.

Results

The 1- and 3-year overall survival (OS) rates of the 73 patients were 67.1% and 40.8%, respectively. Twenty-one patients (29%) achieved clinical CR with dCRT alone. Among 35 patients (48%) with clinical PR, 31 underwent SALV and 4 opted for non-surgical treatments. In the dCRT-alone group (n = 42), patients with clinical CR-PR (n = 25) showed significantly better 3-year OS than those who responded poorly to dCRT (stable or progressive) (n = 17) (67.5% vs. 0%, P < 0.001). In the SALV group (n = 31), curative SALV (n = 22, 73%) provided significantly better 3-year OS than non-curative SALV (58.7% vs. 0%, P < 0.001). Multivariable analysis revealed stenosis before dCRT (P = 0.02) and pretreatment elevated CRP (P = 0.02) to be independently associated with poor outcomes.

Conclusions

The multimodal treatment strategy combining dCRT and SALV is rational for treating cT4 ESCC patients. When curative resection is feasible, SALV can provide good long-term survival outcome for patients who responded to dCRT but did not achieve clinical CR with dCRT alone.

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Abbreviations

ESCC:

Esophageal squamous cell carcinoma

EC:

Esophageal carcinoma

dCRT:

Definitive chemoradiotherapy

SALV:

Salvage surgery

CT:

Computed tomography

LN:

Lymph node

CR:

Complete response

PR:

Partial response

PD:

Progressive disease

SD:

Stable disease

C–D:

Clavien–Dindo

CRP:

C-reactive protein

HR:

Hazard ratios

CI:

Confidence intervals

OS:

Overall survival

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Kotaro Sugawara, Koichi Yagi, Yasuhiro Okumura, Masato Nishida, Susumu Aikou, Hiroharu Yamashita & Yasuyuki Seto

  2. Department of Bariatric and Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Susumu Aikou

  3. Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Hideomi Yamashita

Authors
  1. Kotaro Sugawara
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  8. Yasuyuki Seto
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Correspondence to Yasuyuki Seto.

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Sugawara, K., Yagi, K., Okumura, Y. et al. Long-term outcomes of multimodal therapy combining definitive chemoradiotherapy and salvage surgery for T4 esophageal squamous cell carcinoma. Int J Clin Oncol 25, 552–560 (2020). https://doi.org/10.1007/s10147-019-01590-z

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