Concurrent Chemoradiotherapy Followed by Surgery for Borderline Resectable Esophageal Squamous Cell Carcinoma

Abstract

<h3>Purpose/Objective(s)</h3> This study aimed to clarify the efficacy and safety of induction CRT followed by esophagectomy for borderline resectable esophageal squamous cell carcinoma (BR-ESCC) in which tumors grow very close to the adjacent vital organs. <h3>Materials/Methods</h3> The cohort of this retrospective single-center study included 31 patients who received CRT (41.4 Gy/23 fractions) and radical minimally invasive esophagectomy for T4 BR-ESCC between June 2017 and November 2020. The overall survival (OS), disease-free survival (DFS) and the patterns of recurrence were analyzed. <h3>Results</h3> A total of 14 (45.16%) patients had T4a and 17 (54.84%) had T4b. The median age was 58 (53-65). The clinically involved site were as follows: pleura invasion (15/31), thoracic aorta (14/31), pericardium (13/31), tracheobronchial tree (4/31). The median number of dissected lymph nodes was 28 (16-35). Eight Patients (25.81%) were identified as having a pathologic complete response(pCR). The most surgical complication was anastomotic leakage (16.13%, 5/31) classified as Clavien-Dindo grade II. Respiratory failure was observed in one patient during the early postoperative phase. At a median follow-up interval of 38 months, neither median OS nor DFS was reached. The 3-OS and 3-DFS rates were 62.75% and 61.53%, respectively. Specifically, Patients with pCR showed significantly longer DFS than those who did not (stratified log-rank test: p=0.0301). The OS tended to be better in patients with pCR than in those without pCR (stratified log-rank test: p=0.5635), but not statistically significant. Ten patients (32.3%%) experienced progression during the follow-up period. The recurrence rate of lymph node and distant metastasis were 16.13% (5/31) and 25.81% (8/31). The most frequent metastatic organ was the lung (16.13%) . <h3>Conclusion</h3> The tolerability and efficacy for patients who obtained R0 resection after induction CRT for borderline resectable ESCC was encouraging. The long-term results are worthy of further exploration.