title: Comparison of transthoracic esophagectomy with definitive chemoradiotherapy as initial treatment for patients with esophageal squamous cell carcinoma who could tolerate transthoracic esophagectomy.
abstract: BACKGROUND
  The oncological outcomes of transthoracic esophagectomy (TTE) and definitive chemoradiotherapy (dCRT) as initial treatment in patients with esophageal squamous cell carcinoma (ESCC) who could tolerate TTE remains unclear.
  
  
  METHODS
  Consecutive patients histologically diagnosed with stage I/II/III ESCC (excluding cT4 or cN3) or stage IV ESCC due to supraclavicular lymph node metastasis were eligible for inclusion in this retrospective study. To select patients who could tolerate TTE, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. Patient characteristics, recurrence-free survival (RFS), 3- and 5-year overall survival (OS), pattern of recurrence, and treatments after initial treatment failure were investigated.
  
  
  RESULTS
  Overall, 112 patients were included in the TTE group and 65 were included in the dCRT group. No significant differences were observed in patient characteristics and clinical stage between the TTE and dCRT groups (stage I/II/III/IV of 29/27/46/10 in the TTE group and 23/15/20/7 in the dCRT group). The R0 resection rate was 87 % in the TTE group, and complete response rate was 68 % in the dCRT group. In intention-to-treat analysis, there was no significant difference in RFS. In contrast, 3-year OS of non-stage IA patients was significantly longer in the TTE group than the dCRT group (TTE 66.9 %; dCRT 49.8 %; p = 0.023). In non-stage IA patients, after initial treatment failure significantly more patients could undergo local treatment (radiotherapy or surgery in the TTE group; surgery or endoscopic resection or photodynamic therapy in the dCRT group) in the TTE group than the dCRT group (TTE 74 %; dCRT 40 %; p = 0.003).
  
  
  CONCLUSIONS
  In locally advanced ESCC patients who could tolerate TTE, TTE extended 3-year OS, which might have been encouraged by utilizing local treatment after initial treatment failure.
authors.affiliation: Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Matsuda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tsubosa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Niihara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takebayashi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kawamorita
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsushima
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yokota
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ogawa
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Onozawa
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yasui
authors.forename: Hiroya
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kitagawa
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D059248:Chemoradiotherapy / Q000401:mortality*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy / Q000401:mortality*