Chemoradiotherapy versus surgery for clinical stage I esophageal squamous cell carcinoma: A long-term comparison

Date

08 Oct 2016

Session

Poster Display

Presenters

Seiichiro Mitani

Citation

Annals of Oncology (2016) 27 (6): 207-242. 10.1093/annonc/mdw371

Authors

S. Mitani1, S. Kadowaki2, I. Oze3, T. Masuishi2, Y. Narita2, H. Taniguchi1, T. Ura1, M. Ando1, M. Tajika4, C. Makita5, T. Kodaira5, N. Uemura6, T. Abe6, K. Muro1

Author affiliations

  • 1 Department Of Clinical Oncology, Aichi Cancer Center Hospital, 464-8681 - Nagoya/JP
  • 2 Department Of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya/JP
  • 3 Department Of Epidemiology, Aichi Cancer Center Hospital, Nagoya/JP
  • 4 Department Of Endoscopy, Aichi Cancer Center Hospital, 4648681 - Nagoya/JP
  • 5 Department Of Radiation Oncology, Aichi Cancer Center Hospital, 464-8681 - Nagoya/JP
  • 6 Department Of Gastroenterological Surgery, Aichi Cancer Center Hospital, 464-8681 - Nagoya/JP
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Background

Definitive chemoradiotherapy (CRT) is an alternative to surgery for stage I esophageal squamous cell carcinoma (ESCC). The aim of this study was to evaluate the long-term outcome of CRT and surgery for stage I ESCC.

Methods

Patients (pts) with clinical stage I (cT1N0M0) ESCC treated with CRT or surgery at Aichi Cancer Center Hospital between January 2003 and September 2012 were retrospectively analyzed. Pts were excluded if they had a history of invasive cancer within 1 year before the treatment.

Results

Among 102 pts included, 63 were treated with CRT (cohort C) and 39 with surgery (cohort S). Although there was a higher proportion of pts with Charlson comorbidity index ≥ 1 (39.7% vs. 23.1%), pack-year history of smoking ≥ 30 (65.1% vs. 48.7%) and a past history of cancer (28.6% vs. 10.3%) in cohort C than in cohort S, no statistically significant difference was observed between the two cohorts with respect to pts’ characteristics. Fifty-nine pts (93.7%) achieved a complete response in cohort C, and R0 resection was performed in all pts in cohort S. Only one treatment-related death was observed in cohort C. Recurrences occurred more frequently in cohort C (40.0% vs. 15.3%), most of which were curatively treated by salvage therapy. With a median follow-up of 6.0 years, the 5-year overall survival rates were 83.9% in cohort C and 89.5% in cohort S (HR = 1.72; 95% CI: 0.65–4.53; P = 0.27). The 5-year disease-specific survival rates were similar in both cohorts (91.8% vs. 88.4%; HR = 1.11; 95% CI: 0.34–3.63; P = 0.87). In cohort C, death due to other causes was frequently observed (12.7% vs. 2.6%); in particular, five pts (7.9%) died of a second primary cancer in other organs (second primary). The rate of second primary was 28.6% in cohort C and 12.8% in cohort S.

Conclusions

Our findings suggest that CRT yields a disease-specific survival comparable to surgery for clinical stage I ESCC due to successful salvage therapy after recurrences. A high incidence of second primary indicates the need for surveillance during long-term follow-up.

Clinical trial identification

Legal entity responsible for the study

None

Funding

Aichi Cancer Center Hospital

Disclosure

All authors have declared no conflicts of interest.

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