Management of Clinical Stage T1N0M0 Esophageal Cancer

Abstract

Endoscopic resection is employed as standard treatment for stage T1a esophageal cancer, and esophagectomy or radical radiation therapy (RT) are used for stage T1b lesion. However, the results of each treatment have not been extensively investigated. The purpose of this study was to compare treatment outcomes of each modality for patients with clinical stage T1 esophageal cancer. A total of 179 patients with clinical stage T1N0M0 esophageal cancer from February 2006 to December 2016 were retrospectively evaluated. Sixty-two patients with clinical stage T1a underwent endoscopic resection and 14 of 62 patients were confirmed as pathologic stage T1b following endoscopic resection. Among 117 patients with clinical stage T1b, 82 patients underwent esophagectomy and 35 patients received RT with or without chemotherapy. Median follow-up time was 32 months (range, 1 - 120 months). The 5-year overall survival (OS) and recurrence-free survival (RFS) rate for patients with stage T1a receiving endoscopic resection was 100% and 85%, respectively, For patients with stage T1b, the 5-year OS and RFS rate was 76% and 84% for esophagectomy group and 76% and 72% for RT alone group and 95% and 82% for chemoradiation group, respectively (p=0.501). Esophagectomy group showed significantly higher RFS than RT alone group (p=0.002). There was no significant difference in RFS between esophagectomy and chemoradiation group (p=0.467). Overall, 23 patients (12.8%) experienced treatment failures, which were classified as local in 8 patients (34.8%), regional in 10 patients (43.5%), and distant in 5 patients (21.7%). Among 14 patients diagnosed as stage T1b after endoscopic resection, 7 received adjuvant chemoradiation, and 7 had esophagectomy. Grade 3 or higher treatment-related complication occurred in 4 patients receiving esophagectomy. The endoscopic resection alone provides adequate treatment for patients with stage T1a esophageal cancer. Definitive chemoradiation was comparable to esophagectomy in survival outcome without serious complication for stage T1b esophageal cancer. A randomized controlled trial in the future may clarify these findings.