Definitive chemoradiotherapy versus esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma: A retrospective study. (September 2021)

• Record Type: Journal Article
• Authors: Jo, Yoon Young; Yu, Jesang; Song, Kye Jin; Jang, Jeong Yun; Yoo, Ye Jin; Kim, Sung-Bae; Park, Sook Ryun; Kim, Yong-Hee; Kim, Hyeong Ryul; Kim, Jong Hoon
• Is Part Of: Radiotherapy and oncology. Volume 162(2021)
• Page Start: 112
• Page End: 118
• Publication Date: 2021-09
• Subjects: DCRT definitive chemoradiotherapy -- ECOG Eastern Cooperative Oncology Group -- CCI Charlson-Deyo Comorbidity Index -- CRT chemoradiotherapy -- EGD esophagogastroduodenoscopy -- EUS endoscopic ultrasound -- CT computed tomography -- PET positron emission tomography -- EMR endoscopic mucosal resection -- ESD endoscopic submucosal dissection -- GTV gross target volume -- CTV clinical target volume -- PTV planning target volume -- DMFS distant metastasis-free survival -- FFLP freedom from local progression -- PFS progression-free survival -- OS overall survival -- CCS cancer-specific survival -- LRFS local recur free survival -- LC local control; Definitive chemoradiotherapy (DCRT) -- Radical esophagectomy -- cT1bN0M0 -- Esophageal squamous cell carcinoma (ESCC) -- Comorbidity; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.07.006
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: For cT1bN0M0 esophageal SCC, DCRT was commonly used as a second choice treatment. But DCRT showed equivalent survival to esophagectomy with less complications. DCRT should be recommended as one of standard treatments for all cT1bN0M0 ESCC. Abstract: Background and purpose: This study aimed to determine the equivalence between definitive chemoradiotherapy (DCRT) and radical esophagectomy in clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC). Materials and methods: Among 282 patients with cT1bN0M0 ESCC, 238 underwent radical esophagectomy and 44 underwent DCRT. Both treatments were retrospectively compared overall survival (OS), progression-free survival (PFS), and complications. Results: The DCRT group exhibited poorer patient characteristics than the surgery group, especially with mean age (73 vs. 63 years), Eastern Cooperative Oncology Group (ECOG) status, and Charlson Comorbidity Index ( p < 0.001, each). The median follow-up duration was 49.5 (range, 0.4–97.0) and 45.5 months (range, 5.0–112.0) in the surgery and DCRT groups, respectively. In the DCRT group, clinical complete response was achieved in 43 patients (97.7%) at 1 month after treatment. The 5-year OS rates were 75.8% and 68.8% ( p = 0.135) and the 5-year PFS were 63.8% and 57.8% ( p = 0.637) for the surgery and DCRT groups, respectively. Local recurrence rates were identical between the two groups (11.4% and 11.4%), but the distant metastasis rate was lower in the DCRT group ( n = 1, 2.27% vs. n = 29, 12.15%). Grade 3–4 hematologic toxicities were observed in 11 patients (25%) of the DCRT group, and 56 patients (23.5%) in the surgery group showed grade 3–5 surgical complications, including mortality ( n = 5). Conclusion: Based on the non-inferior survival rates, recurrence patterns, and complication rates without critical surgical mortality, DCRT was comparable to esophagectomy for cT1bN0 esophageal squamous cell carcinoma.