Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study

Esophageal cancer (EC) is an aggressive tumor that represents the 6th most common cause of cancer death worldwide. The estimated incidence in Spain is 2090 cases/year. Two main pathological subtypes exist, squamous cell carcinoma and adenocarcinoma. The main differences between them are localization and underlying factors which are the principal cause of the recent incidence changes observed in west countries. Staging techniques and treatment options which combine surgery, chemotherapy and radiotherapy, reflected the high complexity of the EC management. An undeniably multidisciplinary approach is, therefore, required. In this guide, we review the status of current diagnosis and treatment, define evidence and propose recommendations.

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“…Moreover, surgery remains the first treatment of choice in all T1b-T2N0M0 tumors [12] (E: moderate; R: strong).…”

Section: Treatmentmentioning

confidence: 99%

SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016)

et al. 2016

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“…A further issue to consider is the correct management of clinically staged T2N0 (cT2N0) tumors, which constitute approximately 5-15% of the cases in Western series [36,37]. Considering the limited extent of the disease in these cases, preoperative therapies-burdened by negligible morbidity-could represent overtreatment.…”

Section: Clinical T2n0 Tumorsmentioning

confidence: 99%

“…Despite these considerations, there has been a tendency in more recent years to treat a greater number of cT2N0 patients with multimodal neoadjuvant approaches [35], given that it reportedly yields better biological control of the disease (6-18% of cT2N0 patients treated with multimodal therapy were pathologic complete responders) and a higher rate of radical resection [36][37][38]. However, any observed advantage in terms of overall and disease-free survival comes from comparing multimodality therapy with surgery alone in this clinical setting [36][37][38]. It should be noted that these results cannot be considered to be conclusive, especially because a nonnegligible percentage of clinical N0 cases are actually pathological N?…”

Section: Clinical T2n0 Tumorsmentioning

confidence: 99%

“…It should be noted that these results cannot be considered to be conclusive, especially because a nonnegligible percentage of clinical N0 cases are actually pathological N? (40-50% of such cases are upstaged in upfront surgery) [36][37][38], and those cases could therefore benefit from neoadjuvant treatments [38]. For this reason, parameters such as tumor grade and lymphovascular invasion should be taken into account along with clinical staging when attempting to predict nodal invasion and to identify potentially understaged patients before choosing the treatment plan [38].…”

Section: Clinical T2n0 Tumorsmentioning

confidence: 99%

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Western strategy for EGJ carcinoma

et al. 2016

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In this paper, the epidemiological and clinicobiological behavior of esophagogastric junction (EGJ) adenocarcinoma in the West is compared and contrasted to that in the East, and an overview is provided of current therapeutic strategies employed for this type of tumor in Western countries. It is well known that multimodal treatment is the therapeutic standard in locally advanced EGJ adenocarcinoma, but whether neoadjuvant/perioperative chemotherapy (CT) or neoadjuvant chemoradiotherapy (CRT) is the optimal approach is still debated. Neoadjuvant CRT improves local control in locally advanced Siewert type I and II tumors, so it should be considered the treatment of choice. In the subset of these patients with microscopic systemic disease at diagnosis, more intensive exclusive chemotherapy protocols could be of benefit. Therefore, there is an urgent need to identify these patients before planning the treatment. For Siewert type III tumors, perioperative chemotherapy is the standard. While there is general agreement on the optimal surgical approach for Siewert types I and III (a two-field Ivor Lewis operation and a total gastrectomy with distal esophagectomy, respectively), no standard surgical treatment has been defined for Siewert type II tumors. When data from Western series on proximal and circumferential resection margins and on nodal spread in Siewert type II tumors are taken into account, the optimal surgical approach appears to be Ivor Lewis esophagectomy. Whether the extent of esophageal invasion can correctly predict nodal involvement in middle-upper mediastinal stations as a means to restrict indications for transthoracic esophagectomy requires further investigation in the West.

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“…In this journal, Markar et al reported findings from a retrospective multi-center European study, the FREGAT, about 355 patients with cT2N0M0 EC, extrapolated by a website referring to 30 French-speaking European centres (18). All patients had been staged with CT scan and upper digestive US.…”

mentioning

confidence: 99%

Should cT2N0M0 be managed as a localized or locally advanced esophageal carcinoma?

2017

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Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study

Cited by 71 publications

References 18 publications

SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016)

SEOM Clinical Guideline for the diagnosis and treatment of esophageal cancer (2016)

Western strategy for EGJ carcinoma

Should cT2N0M0 be managed as a localized or locally advanced esophageal carcinoma?

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