Chemo-radiotherapy in Locally Advanced Squamous Cell Oesophageal Cancer—are Upper Third Tumours more Responsive?

Abstract

Before neoadjuvant therapy was widely applied, the prognosis of oesophageal cancer had been considered dependent on the location of the tumor, i.e. upper third cancers had had the worst prognosis. The aim of this retrolective study was to prove the efficiency of the neoadjuvant treatment, and to compare the response of esophageal cancer in different locations. Between January 1998 and September 2005, 102 patients with locally advanced squamous cell oesophageal cancer received preoperative chemo-radiotherapy. In 40 cases the tumor was located in the upper third and in 62 cases in the middle third of the oesophagus. After a four-week-long treatment free period restaging was carried out and patients considered resectable were submitted to surgery. From 40 patients with upper third oesophageal cancer 28 underwent oesophageal resection or pharyngo-laryngectomy. Thiry-five percent a complete histopathological remission was observed. From 62 patients with middle third oesophageal cancer 43 underwent oesophageal resection. Histological examination of the resected specimens documented complete response only in three patients. The median survival and the R0 resection rate were similar in the two groups. Although the resection rate, perioperative morbidity, mortality and the median survival were similar in the two groups, a significantly higher rate of complete response (p < 0,05) was observed in patients with upper third oesophageal cancer compared to patients with middle third oesophageal cancer. It seems that upper third oesophageal cancer has superior sensitivity to multimodal treatment therefore our results may support that upper third location is not an unfavorable prognostic factor any more.

Site-Specific Variation in Familial Cancer as Suggested by Family History, Multiple Primary Cancer, Age at Onset, and Sex Ratio Associated With Upper, Middle, and Lower Third Esophageal and Gastric Cardia Carcinoma

“…Papp et al once compared the effect of 4-week-long preoperative chemoradiotherapy between 40 cases of upper-third ESCC and 62 cases of middle-third ESCC. In the end, complete remission was achieved in 35% (14/40) of the former group but in only 4.8% (3/62) of the latter group (P <0.05), suggesting a sitespecifically different tumor biology (14).…”

Direct Effects of Chemoradiotherapy following Esophagectomy

“…Thus, surgery may play a role in the salvage treatment of patients who were defined nonresponders to induction therapy, but in patients who were defined as responders, surgery can no longer be recommended as a routine treatment. If there is no evidence of residual disease or stricture at the pharyngo-esophageal junction, the patient can be closely followed and surgery may be avoided [18,19]. Our prospective clinical study examined the effects of chemoradiotherapy on postoperative organ function, inflammatory response and the nutritional status.…”

Primary gross tumor volume is prognostic and suggests treatment in upper esophageal cancer

“…The current treatment modalities for upper ESCC are mainly radiotherapy, surgery, or radiotherapy in combination with surgery. In addition, some studies have shown that concurrent chemoradiotherapy was effective against upper third ESCC [ 11 , 12 ], or that upper third EC was especially sensitive to preoperative chemoradiotherapy, which significantly improved survival [ 13 ]. Surgery has even been demonstrated recently as better than radiotherapy for therapeutic effect in upper third ESCC [ 14 ].…”