Optimal Adjuvant Treatment for Curatively Resected Thoracic Esophageal Squamous Cell Carcinoma: A Radiotherapy Perspective
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Purpose The purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments. Materials and Methods One hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), diseasefree survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated. Results At a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups. Conclusion Adjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.
Abstract
Purpose The purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments. Materials and Methods One hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), diseasefree survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated. Results At a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups. Conclusion Adjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.
참고문헌 (25)
- Torre LA, "Global cancer statistics, 2012", CA Cancer J Clin, 65, pp.87~108 (2015)
- Ajani JA, "Esophageal and esophagogastric junction cancers, version 1.2015", J Natl Compr Canc Netw, 13, pp.194~227 (2015)
- Stahl M, "Oesophageal cancer:ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up", Ann Oncol, 24(Suppl 6), pp.vi51~vi56 (2013)
- van Hagen P, "Preoperative chemoradiotherapy for esophageal or junctional cancer", N Engl J Med, 366, pp.2074~2084 (2012)
- Nakagawa S, "Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy", J Am Coll Surg, 198, pp.205~211 (2004)
- Ando N, "Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus : a Japan Clinical Oncology Group Study : JCOG 9204", J Clin Oncol, 21, pp.4592~4596 (2003)
- Xiao ZF, "Value of radiotherapy after radical surgery for esophageal carcinoma : a report of 495 patients", Ann Thorac Surg, 75, pp.331~336 (2003)
- Lyu X, "Adjuvant chemotherapy after esophagectomy: is there a role in the treatment of the lymph node positive thoracic esophageal squamous cell carcinoma", J Surg Oncol, 110, pp.864~868 (2014)
- Xu Y, "Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer", Radiat Oncol, 8, pp.116~ (2013)
- Chen J, "Postoperative radiation therapy with or without concurrent chemotherapy for node-positive thoracic esophageal squamous cell carcinoma", Int J Radiat Oncol Biol Phys, 86, pp.671~677 (2013)
- Kim DJ, "Thoracoscopic esophagectomy for esophageal cancer : feasibility and safety of robotic assistance in the prone position", J Thorac Cardiovasc Surg, 139, pp.53~59 (2010)
- 박승용, "The Role of One-Year Endoscopic Follow-Up for the Esophageal Remnant and Gastric Conduit after Esophagectomy with Gastric Reconstruction for Esophageal Squamous Cell Carcinoma", Yonsei Medical Journal, 54(2), pp.381~388 (2013), 연세대학교의과대학[DOI]
- Park SY, "Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy:experience with 114 consecutive patients with intrathoracic esophageal cancer", Dis Esophagus, 29, pp.326~332 (2016)
- Gray RJ, "A class of K-sample tests for comparing the cumulative incidence of a competing risk", Ann Stat, 16, pp.1141~1154 (1988)
- Fine JP, "A proportional hazards model for the subdistribution of a competing risk", J Am Stat Assoc, 94, pp.496~509 (1999)
- Eisenhauer EA, "New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)", Eur J Cancer, 45, pp.228~247 (2009)
- Zieren HU, "Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus : a prospective randomized study", World J Surg, 19, pp.444~449 (1995)
- Fok M, "Postoperative radiotherapy for carcinoma of the esophagus : a prospective, randomized controlled study", Surgery, 113, pp.138~147 (1993)
- Teniere P, "Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research", Surg Gynecol Obstet, 173, pp.123~130 (1991)
- Xiao ZF, "Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy : report of 549 cases", Int J Radiat Oncol Biol Phys, 62, pp.82~90 (2005)
- Chen J, "Number and location of positive nodes, postoperative radiotherapy, and survival after esophagectomy with three-field lymph node dissection for thoracic esophageal squamous cell carcinoma", Int J Radiat Oncol Biol Phys, 82, pp.475~482 (2012)
- Schreiber D, "Impact of postoperative radiation after esophagectomy for esophageal cancer", J Thorac Oncol, 5, pp.244~250 (2010)
- Zhang J, "Adjuvant chemotherapy of cisplatin, 5-fluorouracil and leucovorin for complete resectable esophageal cancer : a casematched cohort study in east China", Dis Esophagus, 21, pp.207~213 (2008)
- Chen G, "Adjuvant radiotherapy after modified Ivor-Lewis esophagectomy: can it prevent lymph node recurrence of the mid-thoracic esophageal carcinoma", Ann Thorac Surg, 87, pp.1697~1702 (2009)
- Ma DY, "Concurrent three-dimensional conformal radiotherapy and chemotherapy for postoperative recurrence of mediastinal lymph node metastases in patients with esophageal squamous cell carcinoma : a phase 2 single-institution study", Radiat Oncol, 9, pp.28~ (2014)