title: Is the outcome of a salvage surgery for T4 thoracic esophageal squamous cell carcinoma really poor?
abstract: BACKGROUND
  Among patients with T4 thoracic esophageal squamous cell carcinoma (TESCC), it is unclear whether the outcomes of late responders who undergo high-dose chemoradiotherapy (CRT) followed by salvage esophagectomy differs from those of early responders who undergo low-dose CRT followed by esophagectomy.
  
  
  METHODS
  A total of 153 patients with T4 TESCC were treated with CRT. The first evaluation was performed after 40 Gy of CRT for downstaging. Of these, 28 patients could be downstaged, and underwent subsequent surgery (early responders). For the remaining patients, additional CRT was administered, and patients were re-evaluated after treatment and underwent salvage surgery. In total, 40 patients (early + late responders) were analyzed.
  
  
  RESULTS
  The primary tumors exhibited a grade 3 response in six (21.4 %) of the early responders and two (16.7 %) of the late responders (p = 1.000). The rate of residual tumor in the primary tumor was 80 % (32/40 patients). The proportions of resected lymph nodes and positive metastatic nodes were similar between early and late responders (p = 0.406 and p = 0.859, respectively). The 5-year overall survival rates among the early and late responders were 25.9 and 36.5 %, respectively, and the median survival times were 24.8 and 24.3 months (p = 0.925), respectively. The 5-year cause-specific survival rates in the early and late responder groups were 61.5 and 72.9 % (p = 0.425), respectively.
  
  
  CONCLUSIONS
  The outcomes of both early and late responders to CRT were similar, and salvage surgery for T4 TESCC outweighs the risks in patients with T4 TESCC.
authors: Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan, yakutsu@faculty.chiba-u.jp.
authors: Yasunori
authors: Y
authors: Akutsu
authors: Tsuguaki
authors: T
authors: Kono
authors: Masaya
authors: M
authors: Uesato
authors: Isamu
authors: I
authors: Hoshino
authors: Kentaro
authors: K
authors: Murakami
authors: Tomoyoshi
authors: T
authors: Aoyagi
authors: Takumi
authors: T
authors: Ota
authors: Takeshi
authors: T
authors: Toyozumi
authors: Hiroshi
authors: H
authors: Suito
authors: Hiroki
authors: H
authors: Kobayashi
authors: Rintaro
authors: R
authors: Harada
authors: Takashi
authors: T
authors: Uno
authors: Hisahiro
authors: H
authors: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery* / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery* / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome