Outcomes of Definitive Chemoradiotherapy for Stage IVa (T4b vs. N4) Esophageal Squamous Cell Carcinoma Based on the Japanese Classification System: A Retrospective Single-Center Study.

Yuki Wada,Manabu Hashimoto,Hiroshi Nanjo,Satoshi Kumagai,Yusuke Sato,Noriko Takagi,Satoru Motoyama,Akira Anbai,Eriko Okuyama

doi:10.3390/cancers13010008

Yuki Wada, Manabu Hashimoto + Show 7 more

Open Access

https://doi.org/10.3390/cancers13010008

Copy DOI

Journal: Cancers	Publication Date: Dec 22, 2020
Citations: 1	License type: CC BY 4.0

Affiliation: Akita University, Akita University Hospital

Abstract

Simple SummaryDefinitive chemoradiotherapy is a standard treatment for stage IVa esophageal cancer, although it is unclear whether T/N factors affect treatment outcomes and whether we should modify chemoradiotherapy regimens based on T/N factors. This single-center retrospective study aimed to determine whether T/N factors affected progression patterns and overall survival after chemoradiotherapy for stage IVa esophageal squamous cell carcinoma. There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, or progression patterns. Therefore, it may not be useful to modify chemoradiotherapy regimens based on T/N factors for patients with stage IVa squamous cell carcinoma.The differences in prognoses or progression patterns between T4b non-N4 and non-T4b N4 esophageal squamous cell carcinoma post chemoradiotherapy (CRT) is unclear. This study compared the outcomes of CRT for stage IVa esophageal squamous cell carcinoma according to T/N factors. We retrospectively identified 66 patients with stage IVa esophageal squamous cell carcinoma who underwent definitive CRT at our center between January 2009 and March 2013. The treatment outcomes, i.e., progression patterns, prognostic factors, and toxicities based on version 5.0 of the National Cancer Institute Common Terminology Criteria for Adverse Events, were studied. The patients (56 men and 10 women) had a median age of 67 (range: 37–87) years. The T/N classifications were T4b non-N4 (28/66), non-T4b N4 (24/66), and T4b N4 (14/66). Objective response was achieved in 57 patients (86.4%, (95% confidence interval, 74.6–94.1%)). There were no significant differences between the T/N groups in terms of overall survival, progression-free survival, and progression pattern. We found no significant differences in prognoses or progression patterns among patients with T4b non-N4, non-T4b N4, and T4b N4 esophageal squamous cell carcinoma. Thus, it seems impractical to modify CRT regimens based on T/N factors.

Highlights

Esophageal cancer in Japan has a high mortality rate [1] and was reported in 2016–2017 as the 13th most common cancer [2]
It is important to clarify the recurrence pattern after CRT. In this retrospective study, we aimed to evaluate the outcomes of CRT for stage IVa esophageal squamous cell carcinoma and identify differences according to T/N factors that might permit modification of the radiotherapy and/or chemotherapy strategies
We compared the outcomes of CRT for stage IVa esophageal squamous cell carcinoma according to T/N factors and found a median OS of 13 months, a 2-year OS rate of 31.6%, and a complete response (CR) rate of 16.7%; objective response was achieved in 86.4% of the patients

Summary

Introduction

Esophageal cancer in Japan has a high mortality rate [1] and was reported in 2016–2017 as the 13th most common cancer [2]. In Japan, clinical staging of esophageal cancer can be determined based either on the Japanese Classification of Esophageal Cancer (edited by the Japanese Esophageal Society) [4] or the tumor, node, metastasis (TNM) classification of malignant tumors (edited by the Union For International Cancer Control (UICC)) [5] Definitive CRT with the combination of full-dose radiation therapy and a full course of chemotherapy can sometimes induce treatment-related toxicities that cause delays in ongoing CRT or result in termination; it would be favorable to reduce these toxicities by modifying the fields or doses of radiation therapy or the courses of chemotherapy To consider this modification, it is important to clarify the recurrence pattern after CRT. In this retrospective study, we aimed to evaluate the outcomes of CRT for stage IVa esophageal squamous cell carcinoma (based on the Japanese classification) and identify differences according to T/N factors that might permit modification of the radiotherapy and/or chemotherapy strategies

Objectives

Methods

Results

Discussion

Conclusion