Evaluation of Neoadjuvant Chemoradiotherapy Followed by Surgery for Borderline Resectable Esophageal Squamous Cell Carcinoma

Abstract

Background It is occasionally difficult to diagnose cT3 or cT4b using imaging examinations for esophageal cancer. The optimal treatment strategy for borderline resectable esophageal squamous cell carcinoma (BR-ESCC) is unclear. Methods We included 131 patients with cT3 ESCC who received neoadjuvant chemoradiotherapy (NCRT) followed by surgery. The patients were classified as having definitive cT3 (D-cT3) or borderline resectable cT3 (BR-cT3), based on presence of undeniable adjacent organ invasion on pretreatment CT. Surgical outcomes and prognoses were compared among patients with D-cT3 and BR-cT3 tumors, and the risk factors for non-R0 resection were assessed. Results Ninety and 41 patients were classified as D-cT3 and BR-cT3, respectively. Although BR-cT3 had a significantly higher non-R0 resection rate than D-cT3 (D-cT3 3.7%; BR-cT3 14.6%), BR-cT3 was not correlated with shorter overall survival (OS) (D-cT3 5-year OS, 50.8%; BR-cT3 5-year OS 38.4%; p = 0.234). Conversely, non-R0 resection was significantly associated with poor OS (R0 resection 5-year OS 48.8%; non-R0 resection 5-year OS 22.2%; p = 0.031). Cox regression analysis of OS demonstrated that BR-cT3 was not a prognostic factor. In the analysis of risk factors for non-R0 resection, BR-cT3 (p = 0.027), suspected invasion of the trachea or bronchus (p = 0.046), and high SUVmax of the primary lesion after NCRT (p = 0.002) were risk factors. Conclusions NCRT followed by surgery achieved a relatively high R0 resection rate and an almost equal overall survival rate for BR-cT3 compared with D-cT3 ESCC. Thus, NCRT followed by surgery is an effective treatment strategy for patients with BR-cT3 ESCC.

Prognostic factors for esophageal squamous cell carcinoma without pathological lymph node metastasis after neoadjuvant therapy and surgery

“…16,[20][21][22] Elevated pretherapeutic CEA levels may NLR is also a prognostic indicator in patients not only with early but also with advanced ESCC. 3,18,23,24 Neutrophils play an important role in tumor development and progression: they can be mechanistically recruited to the tumor microenvironment, secrete proliferative factors, and suppress T-lymphocyte activity, thus facilitating tumor angiogenesis, invasion, and metastasis. [25][26][27][28] Lymphocytes are also essential components of the immune system because they reduce tumor growth and metastasis through cytotoxic activity, thereby closely associated with tumor surveillance and defense.…”

Surgical intervention after neoadjuvant therapy in esophageal cancer: a narrative review

“…Neoadjuvant therapy combined with surgery is an effective strategy for the treatment of patients with advanced EC ( 59 ), but the choice of surgical method varies for individual patients. Currently available surgical techniques include Ivor Lewis esophagectomy (abdominal and right thoracic incision), McKeown esophagectomy (abdominal, right thoracic, and neck incision), the Sweet procedure (left unilateral thoracotomy), abdominal left thoracotomy, and transesophageal resection, among others ( 60 ).…”

Prognostic Significance of positive lymph node regression grade to Neoadjuvant Chemoradiation for Esophageal Squamous Cell Carcinoma

“…Compared to surgery alone, neoadjuvant therapy followed by surgery improves prognosis in most patients with locally advanced disease at the time of diagnosis. Therefore neoadjuvant therapy plays an important role in the treatment of esophageal cancer in middle and late age [3]. In recent years, several studies have shown that NCRT is superior to neoadjuvant chemotherapy (NAC) owing to long-term survival in therapy of locally advanced esophageal cancer, even in the similarly adverse effect, NCRT provides better short-term bene ts than those associated with NAC combined with immunotherapy, and it is associated with pathological complete response (pCR) rates of up to 49% [4,5] and 5-year overall survival (OS) rates of up to 45% [6].…”