<p>The Role of Adjuvant Chemoradiotherapy Over Radiotherapy After R0 Resection for Stage II-III Esophageal Squamous Cell Carcinoma</p>

Abstract

This study compared the effectiveness and safety of postoperative concurrent chemoradiotherapy (POCRT) containing paclitaxel (PTX) and cisplatin (DDP) with postoperative radiotherapy (PORT) after R0 resection for stage II-III thoracic esophageal squamous cell carcinoma (TESCC). Materials and Methods: After propensity score matching (PSM) analysis, 87 TESCC patients treated with PORT were matched 1:1 to 87 patients who received POCRT between July 2012 and December 2018. Radiotherapy was delivered at a dose of 200 cGy per day to a total dose of 5000 cGy. Concurrent chemotherapy consisted of DDP (25 mg/m 2) for 3 days plus PTX (135 mg/m 2) on day 1 every 3 weeks. Results: Patient-and disease-related characteristics were well-balanced between the two groups. The median overall survival (OS) and disease-free survival (DFS) times were 39.2 and 31.0 months, respectively. The 5-year OS and DFS rates were 31.9% and 19.1% in the PORT group and 45.1% and 35.1% in the POCRT group, respectively. Statistical significance was demonstrated by comparing OS and DFS (P=0.022 and 0.016, respectively). Additionally, subgroup analysis revealed that in node positive TESCC patients, the POCRT group was significantly different from the PORT group regarding OS and DFS (P=0.049 and 0.039, respectively). POCRT decreased distant metastasis over PORT (P=0.044) with manageable toxicities. Multivariate analysis revealed that aside from factors associated with tumor stages, treatment modality was another strong prognostic factor for both OS and DFS (P=0.015 and 0.010, respectively). Conclusion: Stage II-III TESCC patients could benefit from POCRT with manageable toxicities. Future well-designed prospective studies are highly warranted to confirm the findings in our report.

Postoperative Adjuvant Therapy for Patients with pN+ Esophageal Squamous Cell Carcinoma

“…In contrast, Zhang et al [ 26 ] examined patients with TNM stage II/III ESCC and showed that the OS was significantly worse for those who received sequential POCRT rather than PORT or concurrent POCRT. Zou et al [ 27 ], Hsu et al [ 28 ], and Song et al [ 9 ] showed that POCRT significantly increased OS and DFS compared with PORT in patients with pN+ ESCC. The present study also found that POCRT significantly improved OS ( p = 0.034) and DFS ( p = 0.009) compared with POCT.…”

“…A systemic review by Liu et al [ 23 ] concluded that PORT clearly reduced the risk of LR in patients with ESCC. Song et al [ 9 ] reported that POCRT, relative to PORT, administered to patients with pN+ ESCC significantly decreased DM. In contrast, our results and the results of Zou et al [ 27 ] indicated no significant differences in recurrence or DM in groups that received POCRT and PORT.…”

Correlates of Long-Term Survival of Patients with pN+ Esophageal Squamous Cell Carcinoma after Esophagectomy

“…In the study by Li et al [ 10 ], gender showed a significant association with OS and DFS on univariate analysis but not on multivariate analysis. However, in other studies [ 11 , 22 , 25 ], gender was not associated with OS in ESCC patients after surgery.…”

“…In several studies, clinical stage was an independent prognostic factor for OS and DFS in patients with II-III ESCC [ 10 , 11 , 22 , 23 ]. In other studies, pT and pN were independent prognostic factors for OS and DFS [ 17 , 22 , 24 – 26 ]. In the study by Ni et al, OS and DFS were significantly different between stages IIIb and IIIc, but not between IIIa and IIIb on univariate analysis [ 9 ].…”

“…Other studies have also yielded similar results [ 6 , 25 ]. However, in several studies, primary tumor location was not associated with OS and DFS of patients with II-III ESCC after surgery [ 9 – 11 , 17 , 22 ]. This discrepancy is likely attributable to differences with respect to the type of surgery and the study population.…”