Abstract
PurposeThough postoperative radiation for esophageal squamous cell carcinoma is offered in selected cases, there is conflicting evidence as to whether it improves overall survival (OS). A retrospective investigation was performed to analyze the prognostic impact of postoperative radiation therapy (PORT) in a large cohort of patients.MethodsFrom 2001 to 2009, 725 patients underwent radical esophagectomy (R0) with or without PORT were eligible for retrospective analysis. Patients were grouped into surgery alone (n = 467) and surgery plus PORT (n = 258). Median irradiation doses were 50 Gy (range: 40-56 Gy). Radiation fields encompassed the bilateral supraclavicular fossa, mediastinum, subcarinal area, and the tumor bed for the upper/middle-third disease; the bilateral supraclavicular fossa, mediastinum, the tumor bed, subcarinal area, and lower thoracic paraesophageal area for the lower-third disease. Kaplan-Meier and Cox regression analysis were used to compare OS.ResultsAfter median follow-up of 53 months, the median OS was 29 months in the PORT group and 23 months in the surgery alone group. The addition of PORT improved OS at 3 years from 36.6 to 43.6% compared with surgery alone. The use of PORT was associated with significantly improved OS (p = 0.018). For American Joint Committee on Cancer (AJCC) stage III esophageal cancer (T1-2N2M0, T3N1-2M0, T4N1-3M0), there was significant improvement in OS (p = 0.002) in the PORT group, not only for lymph-node metastatic ratio (LNMR) ≥0.25 (p = 0.001), but also for LNMR <0.25 (p = 0.043). However, for stage IIB disease (T1-2N1M0) there was no significant differences. The addition of POCT didn’t prolong the OS significantly (Surgery alone group, p = 0.079; PORT group, p = 0.111).ConclusionsThis large retrospective analysis supports the use of PORT for pathologic lymph node positive stage III esophageal squamous cell carcinoma. Given the retrospective nature of this study, the results should be confirmed by appropriately powered randomized trials. Further development of adjuvant therapy in EC is warranted.
Highlights
Esophageal cancer (EC) is the eighth most common cancer worldwide, and especially in some areas of China is the fourth most common cause of death and is of squamous cell carcinoma (SCC) histology in >90% of cases [1]
The use of postoperative radiotherapy (PORT) was associated with significantly improved overall survival (OS) (p = 0.018)
When analyzing patients with surgery alone group, the median OS and 3-year OS rate were 25 months and 38.0% with surgery alone, 14 months and 30.6% with surgery plus postoperative chemotherapy (POCT) (p = 0.079). The results of this large retrospective study revealed that the addition of PORT is associated with significantly improved OS for American Joint Committee on Cancer (AJCC) lymph node positive stage III ESCC
Summary
Esophageal cancer (EC) is the eighth most common cancer worldwide, and especially in some areas of China is the fourth most common cause of death and is of squamous cell carcinoma (SCC) histology in >90% of cases [1]. Surgery alone has been associated with low cure rates, regardless of surgical approach or histology. Loco-regional recurrence and metastatic spread remain common, despite improvement in surgical techniques and perioperative care. High rates of local and systemic failure have prompted investigation into the multidisciplinary management of those with locally advanced esophageal cancer using neoadjuvant and adjuvant approaches with radiotherapy, chemotherapy, and chemoradiotherapy in an attempt to reduce locoregional recurrence, and to improve outcome after the surgery. Preoperative radiotherapy and chemotherapy are being used more often, and neoadjuvant chemoradiotherapy is currently the standard of care in many western countries [2,3,4,5,6,7,8]. Whether or not postoperative radiotherapy (PORT) and/or postoperative chemotherapy (POCT) affects treatment outcomes, remains controversial [9,10,11,12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
