Outcomes for Esophageal Squamous Cell Carcinoma Treated with Curative Intent in a Western Cohort: Should Multimodal Therapy Be the Gold Standard?
- 40 Downloads
The standard of care for treatment of oesophageal squamous cell carcinoma (SCC) continues to evolve. Neoadjuvant chemoradiotherapy (neoCRT) provides a significant survival benefit compared to surgery alone but it is unclear whether definitive chemoradiation (dCRT) is superior.
Retrospective analysis of outcomes from patients treated in a national high-volume centre (2000–2014) where both neoCRT and dCRT are used with curative intent. Propensity score match analysis was used to match patients undergoing dCRT with those undergoing surgery ± neoCRT.
A total of 668 patients were treated for SCC in this time period, 361 (54.0%) of whom were treated with curative intent. In patients treated with curative intent, 179 (49.6%) had dCRT, and of these 32 (18%) did not complete the treatment regimen. One hundred and seven patients (29.6%) underwent surgery only, and 75 patients (20.8%) had multimodal therapy. The proportion of patients treated with curative intent increased over this time period. The five-year disease-specific and overall survival rate of patients treated with multimodal therapy was 62 and 50%, respectively, compared with 25 and 20% for patients the dCRT group and 44 and 38%, respectively, for the surgery only cohort (p < 0.001). Patients with a complete pathological response had a 90% five-year disease-specific survival and 76% overall survival rate. Multimodal treatment rather than dCRT was a significant predictor of overall survival (OR 1.7 95% CI 1.3–2.4, p = 0.002). In 106 patients matched, those undergoing dCRT had a significantly poorer overall survival versus those receiving surgery as a component of their care (20.47 ± 3.74 months versus 30.65 ± 10.07 months, p = 0.002).
This study provides evidence, consistent with CROSS data, that multimodal therapy for SCC can provide excellent outcomes with respect to overall survival, pathologic complete response rates, R0 resections and treatment-related mortality. A large RCT with specific arms for multimodal, dCRT and surgery alone is required.
The authors would like to acknowledge the contribution of Catherine O’Farrell RGN and Jennifer Moore RGN to patient care and outcomes within the unit.
All authors contributed author roles as defined by ICJME. FS and CLD contributed equally to the paper and should be regarded as first authors.
Compliance with ethical standards
Conflict of interest
The authors declare no commercial or other interests.
- 3.van Hagen P, Hulshof MCCM, van Lanschot JJB, Steyerberg EW, Henegouwen MIVB, Wijnhoven BPL, Richel DJ, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, Cuesta MA, Blaisse RJB, Busch ORC, ten Kate FJW, Creemers G-J, Punt CJA, Plukker JTM, Verheul HMW, Bilgen EJS, van Dekken H, van der Sangen MJC, Rozema T, Biermann K, Beukema JC, Piet AHM, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084CrossRefPubMedGoogle Scholar
- 4.Shapiro J, van Lanschot JJB, Hulshof MC, van Hagen P, van Berge Henegouwen MI, Wijnhoven BP, van Laarhoven HW, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ (2015) Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 16(9):1090–1098CrossRefPubMedGoogle Scholar
- 8.Best LM, Mughal M, Gurusamy KS (2016) Non-surgical versus surgical treatment for oesophageal cancer. Cochrane LibrGoogle Scholar
- 10.Lerut T, Decker G, Coosemans W, De Leyn P, Decaluwé H, Nafteux P, Van Raemdonck D (2009) Quality indicators of surgery for adenocarcinoma of the esophagus and gastroesophageal junction. In: Schneider PM (ed) Adenocarcinoma of the esophagogastric junction. Springer, Berlin, Heidelberg, pp 127–142Google Scholar
- 13.Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, Roussel A, Jacob JH, Segol P, Samama G (1994) Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 73(11):2680–2686CrossRefPubMedGoogle Scholar
- 15.Thoemmes F (2012). Propensity score matching in SPSS. arXiv preprint arXiv:12016385
- 17.Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA, Kelsen DP (2002) INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20(5):1167–1174CrossRefPubMedGoogle Scholar
- 21.Vincent J, Mariette C, Pezet D, Huet E, Bonnetain F, Bouché O, Conroy T, Roullet B, Seitz J-F, Herr J-P (2015) Early surgery for failure after chemoradiation in operable thoracic oesophageal cancer. Analysis of the non-randomised patients in FFCD 9102 phase III trial: chemoradiation followed by surgery versus chemoradiation alone. Eur J Cancer 51(13):1683–1693CrossRefPubMedGoogle Scholar
- 22.Noordman BJ, Shapiro J, Spaander MC, Krishnadath KK, van Laarhoven HW, van Berge Henegouwen MI, Nieuwenhuijzen GA, van Hillegersberg R, Sosef MN, Steyerberg EW (2015) Accuracy of detecting residual disease after cross neoadjuvant chemoradiotherapy for esophageal cancer (preSANO trial): rationale and protocol. JMIR Res Protoc 4(2):e79CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Comparison of systematic surgery versus surveillance and rescue surgery in operable oesophageal cancer with a complete clinical response to radiochemotherapy (esostrate). NCT02551458. https://clinicaltrials.gov/ct2/show/NCT02551458. 1/12/16
- 24.Mariette C, Dahan L, Mornex F, Maillard E, Thomas P-A, Meunier B, Boige V, Pezet D, Robb WB, Le Brun-Ly V (2014) Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol 32(23):2416–2422CrossRefPubMedGoogle Scholar