Neoadjuvant vs definitive concurrent chemoradiotherapy in locally advanced esophageal squamous cell carcinoma patients

Abstract

BackgroundThe optimal treatment for locally advanced esophageal squamous cell carcinoma remains unclear. We compared the clinical outcomes of neoadjuvant concurrent chemoradiotherapy (CCRT) followed by esophagectomy [the surgery group] and CCRT without surgery [the CCRT group] in patients with squamous cell carcinoma from an Asian population.MethodsEligible patients diagnosed from 2008 to 2015 were identified through the Taiwan Cancer Registry. To balance observable potential confounders, we constructed a 1:1 propensity score-matched cohort [surgery vs CCRT]. We compared the hazard ratios between the surgery and CCRT groups for death using a robust variance estimator. We also evaluated the outcomes of patients for freedom from local regional recurrence (FFLRR) and esophageal cancer-specific survival (ECSS). Extensive supplementary analyses were performed to examine the robustness of our findings.ResultsOur study population included 298 patients balanced with respect to the observed covariables. The hazard ratio of death was 0.56 [95% confidence interval 0.42~0.75] when surgery was compared to CCRT. The results remained significant in the FFLRR and ECSS outcomes. In the supplementary analyses, our results also remained significant when additional covariables were taken into consideration or when the definition of the index date was changed.ConclusionsWhen compared to definitive CCRT, neoadjuvant CCRT followed by esophagectomy was associated with improved overall survival for locally advanced esophageal squamous cell carcinoma. However, given the nonrandomized nature of the study and the sensitivity to potentially unmeasured confounders, our results should be interpreted cautiously.

Chemoradiotherapy With or Without Surgery for Esophageal Squamous Cancer According to Hospital Volume

“…The poor 5-year OS reported in this study is not exclusive to Brazil, as similar outcomes have been reported in other observational studies. 22 , 23 Along this line, Chen et al 24 reported a 5-year OS of 20% for patients with locally advanced ESCC treated with dCRT. Similar outcomes have been reported by the WECC esophageal study group, with a 5-year OS of 30% in patients with clinical stage II and III ESCC.…”

Effect of different surgical approaches on the prognosis of patients with postoperative radiotherapy for stage IIB–IVA esophageal squamous cancer

“…Recent studies have shown that for patients with advanced esophageal cancer, recurrence or distant metastasis occurs in more than half of patients after surgery alone [14,15]. And chemotherapy, radiotherapy, and targeted drug therapy, as important adjuvant therapy after esophageal cancer, have attracted more and more attention [16][17][18]. According to the Chinese 2021 Guidelines for Radiation Therapy for Esophageal Cancer, postoperative radiotherapy is recommended for lymph node-positive, pT3-4aN0 stage esophageal cancer, and high-risk pT2N0 adenocarcinoma [19].…”

Impact of the interval between neoadjuvant concurrent chemoradiotherapy and esophagectomy in the modern era: a population-based propensity-score-matched retrospective cohort study in Asia

“…We identified patient demographic factors [age, gender, residency region], patient characteristics [drinking, betel nut chewing, smoking, body mass index (BMI)], disease characteristics [tumor size, tumor differentiation, tumor location, clinical T-stage and N-stage], diagnosis method [use of positron emission tomography (PET)], and treatment characteristics [number of lymph nodes removed, radiotherapy (RT) delivery method, RT dose] as potential confounders based on our experiences in clinical practice and modified from our TCR/NHI related study [6]. These covariables were defined as follows.…”

“…In contrast to the Western world, where adenocarcinoma is the common histology, squamous cell carcinoma (SqCC) is the predominant histology in Asia [2]. For locally advanced esophageal SqCC (LA-ESqCC), neoadjuvant concurrent chemoradiotherapy (nCCRT) is one of the standard-of-care options [3–6].…”