title: Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2 N0 esophageal cancer patients due to inaccurate preoperative staging.
abstract: BACKGROUND
  It remains unclear if patients with clinical stage T2 N0 (cT2 N0) esophageal cancer should be offered induction therapy vs surgical intervention alone.
  
  
  METHODS
  This was a retrospective cohort study of cT2 N0 patients undergoing induction therapy, followed by surgical resection, or resection alone, at the Johns Hopkins Hospital from 1989 to 2009. Kaplan-Meier analysis was used to compare all-cause mortality in cT2 N0 patients who had resection alone vs those who had induction chemoradiation therapy, followed by resection.
  
  
  RESULTS
  A study cohort of 69 patients was identified and divided into two groups: 55 patients (79.7%) received induction therapy and 14 (20.3%) did not. No statistically significant difference in 5-year survival rate was observed for the two groups: 49.5% for the resection-only group and 53.8% for the induction group. More than 50% of cT2 N0 patients were understaged.
  
  
  CONCLUSIONS
  For cT2 N0 esophageal cancer patients, the benefit of neoadjuvant therapy is still unclear. Induction therapy for cT2 N0 did not translate into a statistically significant improvement in survival. However, due to the significant understaging of T2 N0 patients, we recommend neoadjuvant therapy to all cT2N0 patients before operation.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Kimmel Cancer Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
authors.forename: Jennifer Q
authors.initials: JQ
authors.lastname: Zhang
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hooker
authors.forename: Malcolm V
authors.initials: MV
authors.lastname: Brock
authors.forename: James
authors.initials: J
authors.lastname: Shin
authors.forename: Sue
authors.initials: S
authors.lastname: Lee
authors.forename: Remealle
authors.initials: R
authors.lastname: How
authors.forename: Noreli
authors.initials: N
authors.lastname: Franco
authors.forename: Helen
authors.initials: H
authors.lastname: Prevas
authors.forename: Alicia
authors.initials: A
authors.lastname: Hulbert
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003951:Diagnostic Errors; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D060828:Induction Chemotherapy; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D009944:Organoplatinum Compounds; D005472:Fluorouracil