Non-surgical versus surgical treatment for oesophageal cancer

Best, Lawrence; Mughal, Muntzer; Gurusamy, Kurinchi Selvan

doi:10.1002/14651858.cd011498.pub2

Cited by 47 publications

(36 citation statements)

References 40 publications

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“…Although a recent Cochrane review found no difference in long-term mortality or recurrence for patients treated with definitive chemoradiation versus surgery, the quality of evidence was low or very low. 24 Our results demonstrate that patients with squamous cell carcinoma were almost 3 times less likely to have surgical therapy than those with adenocarcinoma. This histology-based deviation provides evidence to support the impact of European guidelines 12 endorsing definitive chemoradiation on practice patterns in the United States.…”

Section: Discussionmentioning

confidence: 59%

Utilization of surgical treatment for local and locoregional esophageal cancer: Analysis of the National Cancer Data Base

Taylor

Greenberg

Lidor

et al. 2016

Cancer

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Background Previous studies suggest esophagectomy is severely underutilized for patients with resectable esophageal cancer. Recent expansion of endoscopic local therapies, advances in surgical techniques and improved postoperative outcomes have changed the therapeutic landscape. The impact of these developments and evolving treatment guidelines on national practice patterns is unknown. Methods Patients diagnosed with clinical stage 0-III esophageal cancer were identified from the National Cancer Data Base (2004-2013). We analyzed receipt of potentially curative surgical treatment over time and used multivariate logistic regression to identify factors associated with surgical treatment. Results 52,122 patients were included in the analysis. From 2004 to 2013, overall rate of potentially curative surgical treatment increased from 36.5% to 47.4% (P<0.001). For stage 0 disease, receipt of esophagectomy decreased from 23.8% to 17.9% (P<0.001), while use of local therapies increased from 34.3% to 58.8% (P<0.001). Use of surgical treatment increased from 43.4% to 61.8% (P <0.001), 36.1% to 45.0% (P<0.001) and 30.8% to 38.6% (P<0.001) for patients with stage I, II and III disease, respectively. On multivariate analysis, divergent practice patterns and adherence to national guidelines were noted between academic and community facilities. Conclusion Use of potentially curative surgical treatment has increased for patients with stage 0-III esophageal cancer. Expansion of local therapies has driven increased rates of surgical treatment for early stage disease. While increased use of esophagectomy for more advanced disease is encouraging, significant variation persists at the patient and facility level.

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Section: Discussionmentioning

confidence: 59%

Utilization of surgical treatment for local and locoregional esophageal cancer: Analysis of the National Cancer Data Base

Taylor

Greenberg

Lidor

et al. 2016

Cancer

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“…Alongside the immediate complications of chemoradiotherapy, an overall long‐term stricture rate of 58% exists and the failure in many cases to improve dysphagia scores. This problem with definitive chemoradiotherapy for oesophageal SCC has also been highlighted in a recent Cochrane review, which demonstrated equivalence in survival between surgical and non‐surgical treatment of oesophageal SCC, but drew attention to the increased dysphagia and strictures in the non‐surgical cohort . Oncologists and patients need to understand this very real risk of strictures after definitive non‐surgical therapy for oesophageal SCC, to ensure appropriate referral for early consideration of intervention.…”

Section: Discussionmentioning

confidence: 99%

“…In the west, approximately 37% of OCs are squamous cell carcinomas (SCCs) and 57% are adenocarcinoma . Whilst surgical resection has been recommended for adenocarcinoma regardless of other modalities used, there is ongoing debate on the necessity of surgical resection for SCC given both its higher sensitivity to chemoradiotherapy, as well as its more proximal location in the oesophagus, leading to higher surgical morbidity . A recent review concluded that there was probably equivalence in survival outcome between definitive chemoradiation versus surgery (hazard ratio 0.88, 95% confidence interval 0.76–1.03) in oesophageal SCC, but also highlighted that patients treated with definitive chemoradiotherapy were more likely to experience dysphagia than those who underwent surgery …”

Section: Introductionmentioning

confidence: 99%

Stricture rate after chemoradiotherapy and radiotherapy for oesophageal squamous cell carcinoma: a 20‐year experience

Hamer

Hight

Ward

et al. 2019

ANZ Journal of Surgery

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Background: Definitive chemoradiation for oesophageal squamous cell carcinoma (SCC) is the first-line treatment in many centres. However, it is not without morbidity. We assess outcomes for patients treated with definitive chemoradiotherapy and radiotherapy. Methods: A retrospective review of a prospectively maintained database (Radiotherapy Department, Canterbury District Health Board) was undertaken. All patients who underwent definitive radiotherapy for oesophageal SCC between October 1996 and April 2015 were included. Results: Sixty patients underwent chemoradiotherapy with curative intent and 17 underwent definitive radiotherapy with curative intent. Median age was 69 years (44-84 years) for those undergoing chemoradiotherapy and 73 years (36-85 years) for those who underwent definitive radiotherapy. Tumour location in all patients was upper third in 14 (18%), middle third in 39 (51%), lower third in 22 (29%) cases and junctional tumour in two (3%). Staging information was complete for 73 of 77 patients (stage I 16/77 (21%), stage II 40/77 (52%), stage III 17/77 (22%)). Median dose of external beam radiotherapy for those who underwent definitive chemotherapy was 50.4 Gy (30-63 Gy) and 60 Gy (50-64 Gy) for definitive radiotherapy. Median length of follow-up was 39 months (range 4-120 months). Strictures developed in 58% of all patients (52% chemoradiotherapy and 76% definitive radiotherapy). Twenty-four (32%) patients were dilated and 14 (18%) stented. The chemoradiotherapy group had higher 5-year survival than definitive radiotherapy group (34% versus 6%, P = 0.0034). Conclusion: Oesophageal SCC treated with chemoradiation has a 5-year survival rate of 34%. Post-treatment strictures occur in 52% of patients with chemoradiotherapy and 76% with definitive radiotherapy.

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“…Also, the 3 year mortality rate was higher in patients who had had surgery when compared to subjects who had been treated with radiotherapy [9]. The main reason behind the failure of surgical methods can be pertained to the systemic attributes of esophageal cancer at the time of treatment [10,11].…”

Section: Introductionmentioning

confidence: 99%

Comparing Two Year Survival Rate of Esophageal Cancer Patients with and without Neoadjuvant Chemoradiotherapy Treatment

Sas¹,

Mahmodlou²,

Ebrahimi³

et al. 2018

Arch Med

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Aim: This study was designed with the aim of determining and comparing the two year survival rate of patients who had, and had not received neoadjuvant chemoradiotherapy. Methods:This analytical study, approved by the ethical committee of Urmia University of Medical Sciences, evaluated esophageal cancer patients who had undergone surgery in Imam Khomeini Hospital of Urmia, between the years 2011 and 2016. Subjects were analyzed as two groups: those who were treated with neoadjuvant methods (n=168) and those who had not received this treatment (n=112). Results:The most common symptom in patients was dysphagia in each group (90.4% versus 87.5%) and also the most common types of esophagus cancer in our study was SCC in each group (88% versus 91.07%). A significant variation concerning survival rates between the two groups were observed (P=0.031). According to the Kaplan Meier survival analysis, the average survival rate of the first group (received neoadjuvant chemoradiotherapy) was 42.96 ± 2.74 months and that of the second group (untreated) was 41 ± 3.12 months. It is revealed that a significant variation is present between the two year survival rates of the two study groups (P=0.03). A significant variation was observed between the two groups concerning two year survival rates (P=0.01). Conclusion:Considering the gathered results, our study reveals that pre-operational neoadjuvant chemoradiotherapy is beneficial for the survival rates of patients suffering from esophageal cancer, therefore we recommend that prior to performing invasive treatments, such as surgery, it is beneficial to provide chemoradiotherapy for these patients.

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Non-surgical versus surgical treatment for oesophageal cancer

Cited by 47 publications

References 40 publications

Utilization of surgical treatment for local and locoregional esophageal cancer: Analysis of the National Cancer Data Base

Utilization of surgical treatment for local and locoregional esophageal cancer: Analysis of the National Cancer Data Base

Stricture rate after chemoradiotherapy and radiotherapy for oesophageal squamous cell carcinoma: a 20‐year experience

Comparing Two Year Survival Rate of Esophageal Cancer Patients with and without Neoadjuvant Chemoradiotherapy Treatment

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