Neoadjuvant Chemoradiotherapy and Larynx-Preserving Surgery for Cervical Esophageal Cancer.

Kun-Yao Dai,Wen-Chien Huang,Chih-Wen Chi,Yu-Chao Yu,Yu-Jen Chen,Huan-Chau Lin,Mei-Lin Chan,Yi-Shing Leu,Chung-Hsin Tsai

doi:10.3390/jcm9020387

Abstract

Neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgery is widely used for treating locally advanced esophageal cancer in the thorax. This study evaluated the feasibility of neoadjuvant CCRT as a larynx preservation strategy for treating cervical esophageal squamous cell carcinoma (SCC) by a multidisciplinary team. Fifteen patients with cervical esophageal SCC who received neoadjuvant CCRT and radical surgery at our institution were reviewed. All patients received CCRT using the intensity-modulated radiation therapy with 48 Gy to gross tumor and 43.2 Gy to regional lymphatic basin in 24 fractions. Side effects, clinical tumor responses, pathological responses, and surgical margin status were analyzed. Pathological T down-staging was noted in seven patients (46.7%); pathological complete response was achieved in three patients (20%). Fourteen patients (93.3%) had larynx preservation; eight patients (53.3%) achieved negative surgical margins. The 2-year overall survival, local relapse-free survival, and regional relapse-free survival were 50.6%, 62.2%, and 47.5%, respectively. Neoadjuvant CCRT and larynx-sparing surgery are feasible and tolerable in patients with cervical esophageal SCC. Prospectively designed studies for large patient groups and long-term follow-up results are needed for validating this multimodality therapy.

Highlights

Esophageal cancer has a high risk of recurrence and metastasis with poor prognosis and is the eighth commonest cancer worldwide, with an estimated 456,000 new cases in 2012 (3.2% of total cancers), and the sixth most common cause of death from cancer, with an estimated 400,000 deaths (4.9% of total deaths) [1]
Cervical esophageal cancer (CEC), which is located between the cricoid cartilage and thoracic inlet, is relatively rare, accounting for approximately 5% of all esophageal cancers [3]
Definitive chemoradiation therapy to preserve the larynx is recommended as the standard treatment modality by the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines [10]

Summary

Introduction

Esophageal cancer has a high risk of recurrence and metastasis with poor prognosis and is the eighth commonest cancer worldwide, with an estimated 456,000 new cases in 2012 (3.2% of total cancers), and the sixth most common cause of death from cancer, with an estimated 400,000 deaths (4.9% of total deaths) [1]. As the incidence of esophageal cancer keeps increasing, the clinical investigations remain important. Cervical esophageal cancer (CEC), which is located between the cricoid cartilage and thoracic inlet, is relatively rare, accounting for approximately 5% of all esophageal cancers [3]. CEC treatment differs from that of thoracic esophageal cancer because of the complicated structures around the cervical esophagus. Radical resection of CEC via pharyngo-laryngo-esophagectomy is the most common method [7,8,9]; it is highly likely to cause morbidity and compromise quality of life. Definitive chemoradiation therapy (dCRT) to preserve the larynx is recommended as the standard treatment modality by the National Comprehensive Cancer Network and European Society for Medical Oncology guidelines [10]

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