Abstract
The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and recently, good clinical outcomes of this treatment have been reported. This study compared prognosis after definitive chemoradiotherapy with radical esophagectomy. From January 2011 to December 2019, 68 consecutive patients who were diagnosed clinical T1bN0M0 squamous cell carcinoma were enrolled and investigated retrospectively. Patients were classified into two groups whether treated by surgery or definitive chemoradiotherapy. Survival outcomes were compared, and subsequent therapies after recurrence were also investigated. Among 68 patients, 39 patients underwent surgery and 29 patients received definitive chemoradiotherapy. No significant difference was noted in overall survival between the two groups. However, the rate of 5-year recurrence-free survival was significantly lower in definitive chemoradiotherapy group than that of surgery group (91.1 vs. 62.7%, hazard ratio 3.976, 95% confidence interval 1.076-14.696, p = 0.039). Patients who had local recurrence after definitive chemoradiotherapy received endoscopic submucosal dissection or photodynamic therapy as salvage therapies, which resulted in no disease progression and a good prognosis. Definitive chemoradiotherapy may become a promising alternative therapy comparable with radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma. Early detection of recurrence by frequent follow-up after definitive chemoradiotherapy is important to control disease within local recurrence, and salvage therapy for local lesions could contribute to long-term survival.
Highlights
The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy
The median duration of follow-up was 44.9 (3.9–112.2) months in surgery group and 50.2 (4.2–109.1) months in Definitive chemoradiotherapy (dCRT) group. Clinical characteristics such as age, gender, the population of smoker and drinker, Eastern Cooperative Oncology Group (ECOG) performance status (PS), comorbidities of diabetes mellitus, old myocardial infarction, arrhythmia and chronic hepatitis, history of gastrectomy and lung resection, renal and respiratory function were similar between two groups
This study revealed that Overall survival (OS) of dCRT was equivalent to that of radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC), despite the rate of recurrence free survival (RFS) being lower in dCRT than esophagectomy
Summary
The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and good clinical outcome of this treatment has been reported. Multidisciplinary treatments have been developed for esophageal squamous cell carcinoma (ESCC), the high degree of recurrence and poor prognosis remain significant challenges [2, 3]. According to the 2017 esophageal cancer practice guidelines in Japan, promulgated by the Japan Esophageal Society, radical esophagectomy with regional lymph node (LN) dissection is a standard treatment for patients with clinical stage I, II, or III ESCC [5, 6]. Good clinical outcomes of dCRT for patients with clinical stage I ESCC have been reported [8]
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