Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy
Objective: This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT. Summary backgr...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2022-07-01
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| Series: | Therapeutic Advances in Medical Oncology |
| Online Access: | https://doi.org/10.1177/17588359221108693 |
| _version_ | 1818041825271742464 |
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| author | Lin-Rui Gao Chen Li Weiming Han Wenjie Ni Wei Deng Lijun Tan Zongmei Zhou Dongfu Chen Qinfu Feng Jun Liang Jima Lv Wenqing Wang Wenyang Liu Lei Deng Xin Wang Tao Zhang Jianyang Wang Yirui Zhai Nan Bi Lvhua Wang Zhouguang Hui Ye-Xiong Li Zefen Xiao |
| author_facet | Lin-Rui Gao Chen Li Weiming Han Wenjie Ni Wei Deng Lijun Tan Zongmei Zhou Dongfu Chen Qinfu Feng Jun Liang Jima Lv Wenqing Wang Wenyang Liu Lei Deng Xin Wang Tao Zhang Jianyang Wang Yirui Zhai Nan Bi Lvhua Wang Zhouguang Hui Ye-Xiong Li Zefen Xiao |
| author_sort | Lin-Rui Gao |
| collection | DOAJ |
| description | Objective: This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT. Summary background data: Treatment options for cT4 EC include dCRT/RT and nCRT/RT + S, but it is not clear whether the latter provides survival benefit in patients downstaged after nCRT/RT. Methods: From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma (ESCC) were retrospectively analyzed. Patients achieving clinical complete response (cCR) or partial response (PR) after 4-week RT (median dose, 40.7 Gy) and considered fit for surgery were offered esophagectomy. Of the 726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received subsequent surgery (nCRT/RT + S group), 234 patients received dCRT/RT. Results: Median follow-up was 58 months. The 3-year overall survival (OS) and progression-free survival (PFS) rates for all patients were 33.3% and 35.6%, respectively. The corresponding OS and PFS rates were 54.8% and 48.5% in the nCRT/RT + S group versus 30.0% and 22.1% in the dCRT/RT group (both p < 0.0001). After adjusting the confounding variables with inverse probability of treatment weighting, the adjusted 3-year OS rates were 50.4% in the nCRT/RT + S group versus 50.8% in the dCRT/RT group ( p = 0.15). However, the adjusted 3-year PFS rates were significantly different between the two groups (49.0% and versus 38.3%, p = 0.004). Postoperative complications occurred in 18 (24.3%) patients. Conclusion: The long-term survival of cT4 ESCC was improved after the use of three-dimensional CRT. In cT4, EC responded to nCRT/RT, surgery improves PFS but not OS. |
| first_indexed | 2024-12-10T08:36:34Z |
| format | Article |
| id | doaj.art-0143d2e53ec841d6b8d721b8c9de860e |
| institution | Directory Open Access Journal |
| issn | 1758-8359 |
| language | English |
| last_indexed | 2024-12-10T08:36:34Z |
| publishDate | 2022-07-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Medical Oncology |
| spelling | doaj.art-0143d2e53ec841d6b8d721b8c9de860e2022-12-22T01:55:57ZengSAGE PublishingTherapeutic Advances in Medical Oncology1758-83592022-07-011410.1177/17588359221108693Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapyLin-Rui GaoChen LiWeiming HanWenjie NiWei DengLijun TanZongmei ZhouDongfu ChenQinfu FengJun LiangJima LvWenqing WangWenyang LiuLei DengXin WangTao ZhangJianyang WangYirui ZhaiNan BiLvhua WangZhouguang HuiYe-Xiong LiZefen XiaoObjective: This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT. Summary background data: Treatment options for cT4 EC include dCRT/RT and nCRT/RT + S, but it is not clear whether the latter provides survival benefit in patients downstaged after nCRT/RT. Methods: From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma (ESCC) were retrospectively analyzed. Patients achieving clinical complete response (cCR) or partial response (PR) after 4-week RT (median dose, 40.7 Gy) and considered fit for surgery were offered esophagectomy. Of the 726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received subsequent surgery (nCRT/RT + S group), 234 patients received dCRT/RT. Results: Median follow-up was 58 months. The 3-year overall survival (OS) and progression-free survival (PFS) rates for all patients were 33.3% and 35.6%, respectively. The corresponding OS and PFS rates were 54.8% and 48.5% in the nCRT/RT + S group versus 30.0% and 22.1% in the dCRT/RT group (both p < 0.0001). After adjusting the confounding variables with inverse probability of treatment weighting, the adjusted 3-year OS rates were 50.4% in the nCRT/RT + S group versus 50.8% in the dCRT/RT group ( p = 0.15). However, the adjusted 3-year PFS rates were significantly different between the two groups (49.0% and versus 38.3%, p = 0.004). Postoperative complications occurred in 18 (24.3%) patients. Conclusion: The long-term survival of cT4 ESCC was improved after the use of three-dimensional CRT. In cT4, EC responded to nCRT/RT, surgery improves PFS but not OS.https://doi.org/10.1177/17588359221108693 |
| spellingShingle | Lin-Rui Gao Chen Li Weiming Han Wenjie Ni Wei Deng Lijun Tan Zongmei Zhou Dongfu Chen Qinfu Feng Jun Liang Jima Lv Wenqing Wang Wenyang Liu Lei Deng Xin Wang Tao Zhang Jianyang Wang Yirui Zhai Nan Bi Lvhua Wang Zhouguang Hui Ye-Xiong Li Zefen Xiao Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy Therapeutic Advances in Medical Oncology |
| title | Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy |
| title_full | Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy |
| title_fullStr | Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy |
| title_full_unstemmed | Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy |
| title_short | Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy |
| title_sort | survival benefit of surgery in patients with clinical t4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy |
| url | https://doi.org/10.1177/17588359221108693 |
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