Complete Clinical Response After Neoadjuvant Chemoradiotherapy for Squamous Cell Cancer of the Thoracic Oesophagus: Is Surgery Always Necessary?

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Abstract

Background: Neoadjuvant chemoradiotherapy (CT-RT) before oesophagectomy is standard management for squamous cell carcinoma (SCC) of the thoracic oesophagus. The aim of this study was to compare the outcome of patients who had clinical complete response (CR) with neoadjuvant CT-RT + oesophagectomy with the survival of patients who had clinical CR and were not operated on. Patients and Methods: Seventy-seven consecutive patients with SCC of the thoracic oesophagus with CR with neoadjuvant CT-RT presenting at the Regional Center of Esophageal Diseases from 1992 to 2008 were included in this retrospective study on a prospectively collected database. Thirty-nine patients underwent oesophagectomy (CT-RT + oesophagectomy), while 38 (CT-RT) were not operated on because they were considered unfit for surgery or refused the operation. Patients' outcome and survival were compared. Results: In the CT-RT + oesophagectomy group, clinical CR was confirmed after histological examination of the surgical specimen in 27/39 (69.2 %) patients. Five-year overall survival rates were 50.0 % in the CT-RT + oesophagectomy group and 57.0 % in the CT-RT group (p = 0.99); 5-year disease-free survival rates were 55.5 % in the CT-RT + oesophagectomy group and 34.6 % in the CT-RT group (p = 0.15). Even after adjusting for propensity score, age, ASA and clinical stage, the treatment regimen did not show a statistically significant effect on overall survival (adjusted p = 0.65) nor on disease-free survival (adjusted p = 0.15). Conclusion: In our group of patients with clinical CR after neoadjuvant CT-RT for SCC of the thoracic oesophagus, waiting for recurrence and then using salvage surgery did not negatively impact their survival compared to patients treated with surgery. More accurate restaging protocols are warranted to improve decision making after CR with neoadjuvant CT-RT.

Original languageEnglish
Pages (from-to)1375-1381
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number8
DOIs
Publication statusPublished - Aug 2013

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Squamous Cell Neoplasms
Chemoradiotherapy
Esophageal Neoplasms
Esophagectomy
Thorax
Esophagus
Squamous Cell Carcinoma
Survival
Disease-Free Survival
Survival Rate
Esophageal Diseases
Propensity Score
Decision Making
Retrospective Studies
Databases
Recurrence

Keywords

  • Carcinoma, squamous cell
  • Esophageal neoplasms
  • Induction chemotherapy
  • Neoadjuvant therapy
  • Survival analysis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{c19e283836e049bfada5ee173dc299dd,
title = "Complete Clinical Response After Neoadjuvant Chemoradiotherapy for Squamous Cell Cancer of the Thoracic Oesophagus: Is Surgery Always Necessary?",
abstract = "Background: Neoadjuvant chemoradiotherapy (CT-RT) before oesophagectomy is standard management for squamous cell carcinoma (SCC) of the thoracic oesophagus. The aim of this study was to compare the outcome of patients who had clinical complete response (CR) with neoadjuvant CT-RT + oesophagectomy with the survival of patients who had clinical CR and were not operated on. Patients and Methods: Seventy-seven consecutive patients with SCC of the thoracic oesophagus with CR with neoadjuvant CT-RT presenting at the Regional Center of Esophageal Diseases from 1992 to 2008 were included in this retrospective study on a prospectively collected database. Thirty-nine patients underwent oesophagectomy (CT-RT + oesophagectomy), while 38 (CT-RT) were not operated on because they were considered unfit for surgery or refused the operation. Patients' outcome and survival were compared. Results: In the CT-RT + oesophagectomy group, clinical CR was confirmed after histological examination of the surgical specimen in 27/39 (69.2 {\%}) patients. Five-year overall survival rates were 50.0 {\%} in the CT-RT + oesophagectomy group and 57.0 {\%} in the CT-RT group (p = 0.99); 5-year disease-free survival rates were 55.5 {\%} in the CT-RT + oesophagectomy group and 34.6 {\%} in the CT-RT group (p = 0.15). Even after adjusting for propensity score, age, ASA and clinical stage, the treatment regimen did not show a statistically significant effect on overall survival (adjusted p = 0.65) nor on disease-free survival (adjusted p = 0.15). Conclusion: In our group of patients with clinical CR after neoadjuvant CT-RT for SCC of the thoracic oesophagus, waiting for recurrence and then using salvage surgery did not negatively impact their survival compared to patients treated with surgery. More accurate restaging protocols are warranted to improve decision making after CR with neoadjuvant CT-RT.",
keywords = "Carcinoma, squamous cell, Esophageal neoplasms, Induction chemotherapy, Neoadjuvant therapy, Survival analysis",
author = "Carlo Castoro and Marco Scarpa and Matteo Cagol and Rita Alfieri and Alberto Ruol and Francesco Cavallin and Silvia Michieletto and Giampietro Zanchettin and Vanna Chiarion-Sileni and Luigi Corti and Ermanno Ancona",
year = "2013",
month = "8",
doi = "10.1007/s11605-013-2269-3",
language = "English",
volume = "17",
pages = "1375--1381",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York LLC",
number = "8",

}

TY - JOUR

T1 - Complete Clinical Response After Neoadjuvant Chemoradiotherapy for Squamous Cell Cancer of the Thoracic Oesophagus

T2 - Is Surgery Always Necessary?

AU - Castoro, Carlo

AU - Scarpa, Marco

AU - Cagol, Matteo

AU - Alfieri, Rita

AU - Ruol, Alberto

AU - Cavallin, Francesco

AU - Michieletto, Silvia

AU - Zanchettin, Giampietro

AU - Chiarion-Sileni, Vanna

AU - Corti, Luigi

AU - Ancona, Ermanno

PY - 2013/8

Y1 - 2013/8

N2 - Background: Neoadjuvant chemoradiotherapy (CT-RT) before oesophagectomy is standard management for squamous cell carcinoma (SCC) of the thoracic oesophagus. The aim of this study was to compare the outcome of patients who had clinical complete response (CR) with neoadjuvant CT-RT + oesophagectomy with the survival of patients who had clinical CR and were not operated on. Patients and Methods: Seventy-seven consecutive patients with SCC of the thoracic oesophagus with CR with neoadjuvant CT-RT presenting at the Regional Center of Esophageal Diseases from 1992 to 2008 were included in this retrospective study on a prospectively collected database. Thirty-nine patients underwent oesophagectomy (CT-RT + oesophagectomy), while 38 (CT-RT) were not operated on because they were considered unfit for surgery or refused the operation. Patients' outcome and survival were compared. Results: In the CT-RT + oesophagectomy group, clinical CR was confirmed after histological examination of the surgical specimen in 27/39 (69.2 %) patients. Five-year overall survival rates were 50.0 % in the CT-RT + oesophagectomy group and 57.0 % in the CT-RT group (p = 0.99); 5-year disease-free survival rates were 55.5 % in the CT-RT + oesophagectomy group and 34.6 % in the CT-RT group (p = 0.15). Even after adjusting for propensity score, age, ASA and clinical stage, the treatment regimen did not show a statistically significant effect on overall survival (adjusted p = 0.65) nor on disease-free survival (adjusted p = 0.15). Conclusion: In our group of patients with clinical CR after neoadjuvant CT-RT for SCC of the thoracic oesophagus, waiting for recurrence and then using salvage surgery did not negatively impact their survival compared to patients treated with surgery. More accurate restaging protocols are warranted to improve decision making after CR with neoadjuvant CT-RT.

AB - Background: Neoadjuvant chemoradiotherapy (CT-RT) before oesophagectomy is standard management for squamous cell carcinoma (SCC) of the thoracic oesophagus. The aim of this study was to compare the outcome of patients who had clinical complete response (CR) with neoadjuvant CT-RT + oesophagectomy with the survival of patients who had clinical CR and were not operated on. Patients and Methods: Seventy-seven consecutive patients with SCC of the thoracic oesophagus with CR with neoadjuvant CT-RT presenting at the Regional Center of Esophageal Diseases from 1992 to 2008 were included in this retrospective study on a prospectively collected database. Thirty-nine patients underwent oesophagectomy (CT-RT + oesophagectomy), while 38 (CT-RT) were not operated on because they were considered unfit for surgery or refused the operation. Patients' outcome and survival were compared. Results: In the CT-RT + oesophagectomy group, clinical CR was confirmed after histological examination of the surgical specimen in 27/39 (69.2 %) patients. Five-year overall survival rates were 50.0 % in the CT-RT + oesophagectomy group and 57.0 % in the CT-RT group (p = 0.99); 5-year disease-free survival rates were 55.5 % in the CT-RT + oesophagectomy group and 34.6 % in the CT-RT group (p = 0.15). Even after adjusting for propensity score, age, ASA and clinical stage, the treatment regimen did not show a statistically significant effect on overall survival (adjusted p = 0.65) nor on disease-free survival (adjusted p = 0.15). Conclusion: In our group of patients with clinical CR after neoadjuvant CT-RT for SCC of the thoracic oesophagus, waiting for recurrence and then using salvage surgery did not negatively impact their survival compared to patients treated with surgery. More accurate restaging protocols are warranted to improve decision making after CR with neoadjuvant CT-RT.

KW - Carcinoma, squamous cell

KW - Esophageal neoplasms

KW - Induction chemotherapy

KW - Neoadjuvant therapy

KW - Survival analysis

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U2 - 10.1007/s11605-013-2269-3

DO - 10.1007/s11605-013-2269-3

M3 - Article

C2 - 23797888

AN - SCOPUS:84880088432

VL - 17

SP - 1375

EP - 1381

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

IS - 8

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