Open Access

Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients

  • Authors:
    • Yoshinori Fujiwara
    • Reigetsu Yoshikawa
    • Norihiko Kamikonya
    • Tsuyoshi Nakayama
    • Kotaro Kitani
    • Masanori Tsujie
    • Masao Yukawa
    • Masatoshi Inoue
    • Takehira Yamamura
  • View Affiliations

  • Published online on: June 1, 2012     https://doi.org/10.3892/or.2012.1847
  • Pages: 446-452
  • Copyright: © Fujiwara et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

The prognosis of advanced esophageal cancer patients is poor. Trimodality therapy of surgical resection plus neoadjuvant chemoradiotherapy (CRT) has been developed to improve survival through locoregional control, leading to prevention of micrometastasis. We investigated whether or not neoadjuvant CRT led to survival benefits in TNM stage II/III esophageal cancer patients. We retrospectively reviewed 62 patients with stage II or III esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant CRT. All patients received esophagectomy 4-7 weeks after CRT consisting of 40 Gy irradiation and chemotherapy (5-FU, 500 mg/m2/day, days 1-5 and cisplatin, 10-20 mg/body, days 1-5). Clinical response and survival rates were analyzed using Kaplan-Meier methods, with p<0.05 considered as significant. The clinical effect rate of CRT for both primary tumors and metastatic nodes was 82.3%. Operative and hospital mortality rates were 1.65 and 6.5%, respectively. The 3-year overall survival (OS) and disease-free survival (DFS) rates were 52.6 and 49.2%, respectively. A significant difference was noted between stages II and III for both OS and DFS. The 5-year OS rates were 64.2% for stage II, 33.1% for stage III (T4 and non-T4) and 46.9% for stage III (non-T4 only) patients. The depth of tumor invasion (T3 vs. T4), resectability (R0 vs. R1, R2), lymph node metastasis (positive vs. negative), and the effect of CRT were proven to be independent prognostic factors for univariate analysis, with resectability and the effect of CRT for multivariate analysis. These data suggest that CRT in stage II/III (non-T4) ESCC patient contributed to tumor shrinkage, leading to higher resectability and longer survival. Neoadjuvant CRT appears to be a promising option for these patients.
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August 2012
Volume 28 Issue 2

Print ISSN: 1021-335X
Online ISSN:1791-2431

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Spandidos Publications style
Fujiwara Y, Yoshikawa R, Kamikonya N, Nakayama T, Kitani K, Tsujie M, Yukawa M, Inoue M and Yamamura T: Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients. Oncol Rep 28: 446-452, 2012
APA
Fujiwara, Y., Yoshikawa, R., Kamikonya, N., Nakayama, T., Kitani, K., Tsujie, M. ... Yamamura, T. (2012). Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients. Oncology Reports, 28, 446-452. https://doi.org/10.3892/or.2012.1847
MLA
Fujiwara, Y., Yoshikawa, R., Kamikonya, N., Nakayama, T., Kitani, K., Tsujie, M., Yukawa, M., Inoue, M., Yamamura, T."Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients". Oncology Reports 28.2 (2012): 446-452.
Chicago
Fujiwara, Y., Yoshikawa, R., Kamikonya, N., Nakayama, T., Kitani, K., Tsujie, M., Yukawa, M., Inoue, M., Yamamura, T."Trimodality therapy of esophagectomy plus neoadjuvant chemoradiotherapy improves the survival of clinical stage II/III esophageal squamous cell carcinoma patients". Oncology Reports 28, no. 2 (2012): 446-452. https://doi.org/10.3892/or.2012.1847