Do We Need to Add Postoperative Radiotherapy in Patients Undergoing Trimodality Therapy for Esophageal Squamous Cell Carcinoma with Positive Lymph Nodes Disease?

Abstract

Background: The role of adjuvant radiotherapy for positive lymph nodes (LN) in patients with esophageal cancer who received neoadjuvant concurrent chemoradiotherapy (CCRT) is not well established. This study is aimed at determining the impact of positive LN and the survival benefit of postoperative radiotherapy (PORT) after CCRT plus surgery on esophageal cancer patients. Methods: Seventy patients with positive LN after neoadjuvant CCRT followed by esophagectomy were enrolled in the study. Patients were grouped into surgery alone following neoadjuvant CCRT (n = 41) and surgery plus PORT following neoadjuvant CCRT (n = 29) groups. The preoperative radiation dose was 36-45 Gy (mean 40 Gy) and the postoperative radiation dose was 20 Gy in 10 fractions. Results: The 5-year survival rate and mean survival was 40% and 58.6 ± 53.9 months for patients with a pathologic complete response (pCR) compared with 8.3% and 22.7 ± 35.5 months, respectively, for non-pCR patients (p = 0.026). Local and distant recurrent patterns were similar for patients who did and did not receive PORT (p = 0.876). The mean survival did not differ significantly between the 2 groups (p = 0.889). Pathological complete response to CCRT was the only significant factor influencing survival (p = 0.026). Conclusions: Postoperative RT did not improve survival in patients with positive LN after CCRT followed by curative surgery for esophageal cancer.

Radical esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma followed by adjuvant radiotherapy with or without chemotherapy: Which is more beneficial?

“…As to the one‐year overall survival rates, the statistical difference was relatively mild and the difference of one‐year DFS rate was not obvious while it became obvious in the third year. This may have been related to the timeliness of adjuvant therapy and postoperative tumor bed blood circulation disorders, which resulted from the operation damage that had not been completely rebuilt, thus leading to the increased proportion of hypoxic tumor cells . The increase in the proportion of hypoxic tumor cells was associated with decreased sensitivity to radiotherapy and reduced local delivery of chemotherapeutic drugs …”

“…This may have been related to the timeliness of adjuvant therapy and postoperative tumor bed blood circulation disorders, which resulted from the operation damage that had not been completely rebuilt, thus leading to the increased proportion of hypoxic tumor cells. 22,23 The increase in the proportion of hypoxic tumor cells was associated with decreased sensitivity to radiotherapy and reduced local delivery of chemotherapeutic drugs. [24][25][26][27] In this study, there were no differences in the overall recurrence and metastasis rates between the CRT and RT groups, which is opposite to the previous study.…”

Role of Adjuvant Therapy in Esophageal Cancer Patients After Neoadjuvant Therapy and Esophagectomy

“…The initial search yielded 3692 potentially relevant citations, of which a total of 13 studies met inclusion criteria. [16][17][18][19][20][21][22][23][24][25][26][27][28] Despite being eligible, Drake et al, Mokdad et a, Samson et al, Burt et al, and Eng et al all analyzed data from the National Cancer Database (NCDB) within a similar timeframe. 17,18,20,26,29 Although the aforementioned studies contained populations with differing T-stages and nodal statuses, indicating that different patient subgroups within the NCDB were examined, it is likely that they included some overlapping patient data.…”

Adjuvant Chemoradiotherapy Associated with Improved Overall Survival in Resected Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemoradiotherapy in Intensity-Modulated Radiotherapy Era

“…Lee et al concluded that adjuvant therapy after neoadjuvant treatment and curative resection with negative resection margins improved OS at 1 and 5 years with moderate to high certainty of evidence [ 11 ]. However, the studies included in this meta-analysis consisted of various combinations of neoadjuvant therapies (neoadjuvant chemotherapy vs. neoadjuvant CRT) and adjuvant therapies (adjuvant chemotherapy vs. adjuvant CRT vs. adjuvant radiotherapy) [ 11 , 16 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Out of the 10 studies included in the meta-analysis, seven of them included patients treated with neoadjuvant CRT, and out of these seven studies, only one of them investigated the effect of adjuvant CRT [ 11 , 28 ].…”