Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy

Lin-Rui Gao; Chen Li; Weiming Han; Wenjie Ni; Wei Deng; Lijun Tan; Zongmei Zhou; Dongfu Chen; Qinfu Feng; Jun Liang; Jima Lv; Wenqing Wang; Wenyang Liu; Lei Deng; Xin Wang; Tao Zhang; Jianyang Wang; Yirui Zhai; Nan Bi; Lvhua Wang; Zhouguang Hui; Ye-Xiong Li; Zefen Xiao

doi:10.1177/17588359221108693

Survival benefit of surgery in patients with clinical T4 esophageal cancer who achieved complete or partial response after neoadjuvant chemoradiotherapy or radiotherapy

Ther Adv Med Oncol. 2022 Jul 26:14:17588359221108693. doi: 10.1177/17588359221108693. eCollection 2022.

Authors

Lin-Rui Gao¹, Chen Li¹, Weiming Han¹, Wenjie Ni¹, Wei Deng¹, Lijun Tan¹, Zongmei Zhou¹, Dongfu Chen¹, Qinfu Feng¹, Jun Liang¹, Jima Lv¹, Wenqing Wang¹, Wenyang Liu¹, Lei Deng¹, Xin Wang¹, Tao Zhang¹, Jianyang Wang¹, Yirui Zhai¹, Nan Bi¹, Lvhua Wang¹, Zhouguang Hui¹, Ye-Xiong Li², Zefen Xiao²

Affiliations

¹ Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Road, Chaoyang District, Beijing 100021, China.

Abstract

Objective: This study aimed to determine the long-term survival of patients with cT4 esophageal cancer (EC) and whether neoadjuvant chemoradiotherapy/radiotherapy plus surgery (nCRT/RT + S) is superior to definitive CRT(dCRT)/RT in terms of survival in cT4 EC downstaged after nCRT/RT.

Summary background data: Treatment options for cT4 EC include dCRT/RT and nCRT/RT + S, but it is not clear whether the latter provides survival benefit in patients downstaged after nCRT/RT.

Methods: From 2002 to 2017, 726 patients with cT4 esophageal squamous cell carcinoma (ESCC) were retrospectively analyzed. Patients achieving clinical complete response (cCR) or partial response (PR) after 4-week RT (median dose, 40.7 Gy) and considered fit for surgery were offered esophagectomy. Of the 726 patients, 308 (42.4%) achieved cCR/PR, while 74 patients received subsequent surgery (nCRT/RT + S group), 234 patients received dCRT/RT.

Results: Median follow-up was 58 months. The 3-year overall survival (OS) and progression-free survival (PFS) rates for all patients were 33.3% and 35.6%, respectively. The corresponding OS and PFS rates were 54.8% and 48.5% in the nCRT/RT + S group versus 30.0% and 22.1% in the dCRT/RT group (both p < 0.0001). After adjusting the confounding variables with inverse probability of treatment weighting, the adjusted 3-year OS rates were 50.4% in the nCRT/RT + S group versus 50.8% in the dCRT/RT group (p = 0.15). However, the adjusted 3-year PFS rates were significantly different between the two groups (49.0% and versus 38.3%, p = 0.004). Postoperative complications occurred in 18 (24.3%) patients.

Conclusion: The long-term survival of cT4 ESCC was improved after the use of three-dimensional CRT. In cT4, EC responded to nCRT/RT, surgery improves PFS but not OS.

Keywords: clinical T4 stage; definitive chemoradiotherapy/radiotherapy; esophageal squamous cell carcinoma; neoadjuvant treatment; surgery.