Effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma receiving definitive radiotherapy or concurrent chemoradiotherapy through intensity-modulated radiation therapy techniques.
Few large, prospective, randomized studies have investigated the effectiveness of esophagectomy in patients with thoracic esophageal squamous cell carcinoma (TESCC) who receive definitive radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) through modern, intensity modulated-RT (IMRT) techniques. The therapeutic effects of esophagectomy in patients with TESCC were evaluated using modern clinical staging and RT techniques and suitable RT doses.



The authors analyzed data from patients with TESCC from the Taiwan Cancer Registry database. Patients were categorized into the following groups on the basis of treatment modality to compare their outcomes: group 1 received definitive CCRT, group 2 received neoadjuvant RT followed by esophagectomy (total IMRT dose, ≥50 grays [Gy]), and group 3 receiving neoadjuvant CCRT followed by esophagectomy (total IMRT dose, ≥ 50 Gy). The median total RT dose and fraction size were 50.4 Gy and 1.8 Gy per fraction, respectively. Group 1 was used as the control arm for investigating the risk of mortality after treatment.



In total, 3123 patients who had TESCC without distant metastasis were enrolled. Patient ages 65 years and older, Charlson comorbidity index scores ≥3, advanced clinical stages (IIA-IIIC), alcohol consumption, and cigarette smoking were identified as significant, independent poor prognostic risk factors for overall survival in multivariate Cox regression analyses. In group 3, after adjustment for confounders, the adjusted hazard ratios (95% confidence intervals [CIs]) for overall mortality were 0.62 (95% CI, 0.41-0.93) for patients with clinical stage IIA disease, 0.61 (95% CI, 0.41-0.91) for those with clinical stage IIB disease, 0.47 (95% CI, 0.38-0.55) for those with clinical stage IIIA disease, 0.47 (95% CI, 0.39-0.56) for those with clinical stage IIIB disease, and 0.46 (95% CI, 0.37-0.57) for those with clinical stage IIIC disease.



Esophagectomy can be beneficial in patients with TESCC after definitive CCRT, especially in those who have advanced-stage disease. Cancer 2017;123:2043-2053. © 2017 American Cancer Society.
Biostatistics Center and School of Public Health, Taipei Medical University, Taipei, Taiwan.
Yu-Chun
YC
Yen
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Jer-Hwa
JH
Chang
Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Wei-Cheng
WC
Lin
Department of Radiation Oncology, Taipei Medical University Hospital, Taipei, Taiwan.
Jeng-Fong
JF
Chiou
Division of Thoracic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Yin-Chun
YC
Chang
Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Chia-Lun
CL
Chang
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Han-Lin
HL
Hsu
Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Jyh-Ming
JM
Chow
Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Kevin Sheng-Po
KS
Yuan
PhD Program for Translational Medicine, Taipei Medical University, Taipei, Taiwan.
Alexander T H
ATH
Wu
Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Department of Biotechnology, Hungkuang University, Taichung, Taiwan.
Szu-Yuan
SY
Wu
D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D050397:Radiotherapy, Intensity-Modulated; D012042:Registries; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate; D013624:Taiwan; D055815:Young Adult
concurrent chemoradiotherapy; squamous cell carcinoma; survival; thoracic esophageal cancer