title: Using pretreatment tumor depth and length to select esophageal squamous cell carcinoma patients for nonoperative treatment after neoadjuvant chemoradiotherapy.
abstract: BACKGROUND
  Two randomized trials have shown that in patients with good response to neoadjuvant chemoradiotherapy (nCRT), a nonoperative approach (additional CRT) had equal survival to scheduled esophagectomy. However, controversy exists because of the high locoregional recurrence (LR) following a nonoperative approach. Endoscopic complete response (e-CR) determined by endoscopic finding is a good criterion for predicting local control after definitive CRT. We evaluated whether e-CR could also be used to select patients for nonoperative treatment after nCRT.
  
  
  METHODS
  We retrospectively analyzed esophageal squamous cell carcinoma (SCC) patients with e-CR after nCRT between 1999 and 2006. Patients were divided into two groups by the type of treatment given after e-CR (group A, scheduled esophagectomy; group B, no scheduled surgery and continued CRT).
  
  
  RESULTS
  There were 71 and 79 patients in groups A and B, respectively with similar pre/post-nCRT characteristics. Despite similarity in survival and recurrence between groups, the recurrence site differed significantly. LR occurred more frequently in group B, whereas systemic recurrence was the predominant failure pattern in group A (P<.001). With use of multivariate analysis on group B, we determined that pretreatment depth of tumor invasion≥T3 [odds ratio (OR), 11.19; 95% CI, 1.4-89; unfavorable, P=.023] and tumor length≥6 cm (OR, 3.069; 95% CI, 1.17-8.1; unfavorable, P=.023) were predictors for LR. Patients with initial clinical T2 and <6 cm tumor had comparable LR (5%) to the surgery group; these patients were candidates for nonoperative treatment after nCRT.
  
  
  CONCLUSIONS
  In esophageal SCC patients who achieved e-CR after nCRT, pretreatment tumor depth and length were good indicators to select candidates for nonoperative treatment.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Yin-Kai
authors.initials: YK
authors.lastname: Chao
authors.forename: Chen-Kan
authors.initials: CK
authors.lastname: Tseng
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Wen
authors.forename: Yun-Hen
authors.initials: YH
authors.lastname: Liu
authors.forename: Yung-Liang
authors.initials: YL
authors.lastname: Wan
authors.forename: Cheng-Tung
authors.initials: CT
authors.lastname: Chiu
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chang
authors.forename: Hsien-Kun
authors.initials: HK
authors.lastname: Chang
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil