Treatment results of esophageal carcinoma of clinical T3, T4M0: historical comparison between neoadjuvant chemoradiotherapy followed by surgery or definitive radiotherapy and conventional surgery.

Murakami, Maki; Kuroda, Yoshikazu; Matsusue, Satoru; Okita, Yoshiki; Nakajima, T.; Nishimura, Shigeyuki; Kusumi, Fusako; Hajiro, Kiyoshi; Takeda, Haruo

doi:10.3892/or.7.3.571

Cited by 8 publications

(13 citation statements)

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“…Thus, efforts to increase local control may not necessarily translate into improved survival unless systemic therapies also improved. The intensification of chemotherapy through the addition of induction chemotherapy had been in trial to strengthen the systemic therapy, but no consensus response was obtained until now [18,19]. To improve both local and distant control in patients with EC, new regimens must be developed.…”

Section: Discussionmentioning

confidence: 99%

Involved-field irradiation in definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

Zhang

Meng

et al. 2014

Radiat Oncol

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BackgroundSince there is high local failure and poor survival for unresectable esophageal squamous cell carcinoma (ESCC), the necessity of elective node irradiation is controversial. The purpose of this study was to investigate the failure patterns and survival in patients with locally advanced ESCC receiving involved-field irradiation (IFI).MethodsA retrospective study was preformed on the clinical records of patients with locally advanced ESCC, who have received IFI with concurrent chemotherapy between January 2003 and January 2009. Comparing the target volume and first sites of failure, patterns of failure were defined as in-field, out-of-field regional lymph node and distant failure. The survivals were analyzed by different patterns of failure.ResultsEighty patients were included in our study. With a median follow-up of 52.6 months, failures were observed in 76 patients. In-field recurrence, distant metastasis, and out-of-field regional failure were seen in 53.75%, 41.25%, 30% patients, respectively. There were significant differences in OS for patients with and without in-field (median OS 14.2 vs.17.4 m, P = 0.01)or distant failure(13.2 vs.15.9 m, P ≤ 0.0001), but not for out-of-field regional lymph node failure(both 14.5 m, P = 0.665).ConclusionsThe solitary regional nodal failure of out-of-field was acceptable in advanced ESCC patients treated with IFI. In-field and distant failures remained the predominant patterns and negatively impacted survival more significantly. Further investigation is needed to establish the optimal radiotherapy field for these patients at advanced stage.

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Section: Discussionmentioning

confidence: 99%

Involved-field irradiation in definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

Zhang

Meng

et al. 2014

Radiat Oncol

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“…Other investigators have reported similar data from studies that, once again, tended to select responding patients for surgery, and non‐responders for further chemoradiation; the two treatments have produced equivalent survival results 45–47 . Instead of selecting responding patients for surgery, Murakami et al offered surgery to non‐responding patients and further radiation to responders (selecting less favorable patients for esophagectomy) 48 . Survival was similar for both groups (5‐year survival of approximately 30%).…”

Section: Introductionmentioning

confidence: 87%

Salvage or planned esophagectomy after chemoradiation therapy for locally advanced esophageal cancer – a review

Urschel

Ashiku

Thurer

et al. 2003

Diseases of the Esophagus

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Definitive chemoradiation (without esophagectomy) and neoadjuvant chemoradiation followed by planned esophagectomy are commonly used treatments for locally advanced esophageal cancer. These two treatment strategies have similar survival outcomes, so the value of planned esophagectomy is debated. However, persistence or recurrence of local disease is not uncommon after definitive chemoradiation. Salvage esophagectomy for isolated local failures of definitive chemoradiation is an option for selected patients. In this article we review the debate over definitive chemoradiation versus neoadjuvant chemoradiation and surgery, and then restate the argument in terms of salvage versus planned esophagectomy. Although both forms of esophagectomy are done in the setting of previous chemoradiation, they are different in several ways. Salvage esophagectomy appears to be a more morbid operation than planned esophagectomy. Surgeons supportive of the salvage esophagectomy strategy face the challenge of reducing its postoperative mortality.

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“…27) We also had started a prospective non-randomized trial comparing chemoradiotherapy with surgery versus without surgery for un-resectable T4 esophageal cancers. In 2005, we reported the results from this trial showing that surgery did not offer any survival benefit for responders to neo-adjuvant chemoradiotherapy, but might offer a survival benefit for non-responders.…”

Section: The 3rd Stage Of Esophageal Surgery In Japanmentioning

confidence: 99%

A History of Surgery for Locally-Advanced (T4) Cancer of the Thoracic Esophagus in Japan and a Personal Perspective

Fujita

2013

ATCS

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The history of esophageal surgery in Japan can be divided into three periods, an era of safety from 1930 to 1980, an era of radicality from 1980 to 2000, and the era of quality of life (QOL) from 2000 to the present. The treatment for T4 cancers of the thoracic esophagus has also changed over time from preoperative radiotherapy, combined resection of the neighboring organs with esophagectomy, and to definitive chemoradiotherapy (dCRT) with salvage surgery. At present, almost all patients with an unresectable T4 esophageal cancer receives dCRT. However, there are many patients with a residual or recurrent tumor after dCRT. Salvage surgery for such patients often results in incomplete resection of the tumor because the tumor involves the trachea and/or aorta. New techniques to enable the resection of such neighboring organs even during salvage surgery are needed. In the future, the mainstay of treatment for esophageal cancer will be CRT with the foreseeable progress in new drugs and new techniques of radiotherapy. Surgery will be indicated for a local failure after CRT, while combined resection of the neighboring organs will be necessary to treat a local failure after CRT for T4 cancers. New surgical techniques have to be developed through some application of new devices and equipment.

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Treatment results of esophageal carcinoma of clinical T3, T4M0: historical comparison between neoadjuvant chemoradiotherapy followed by surgery or definitive radiotherapy and conventional surgery.

Cited by 8 publications

References 0 publications

Involved-field irradiation in definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

Involved-field irradiation in definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

Salvage or planned esophagectomy after chemoradiation therapy for locally advanced esophageal cancer – a review

A History of Surgery for Locally-Advanced (T4) Cancer of the Thoracic Esophagus in Japan and a Personal Perspective

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