Korean J Gastroenterol.  2024 Mar;83(3):102-110. 10.4166/kjg.2023.100.

Comparison of the Clinical Outcomes of Esophagectomy and Concurrent Chemoradiotherapy in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

• Lee MH
• Park MI
• Lee JW
• Jung K
• Kim JH
• Kim SE
• Moon W
• Park SJ

• KMID: 2554263
• DOI: http://doi.org/10.4166/kjg.2023.100

Abstract

Background/Aims
The efficacy of concurrent chemoradiotherapy (CCRT) or esophagectomy for locally advanced esophageal squamous cell carcinoma (ESCC) is unclear. This study compared the survival and recurrence of patients with locally advanced ESCC after definitive CCRT and surgery.
Methods
A retrospective study was conducted on patients with locally advanced ESCC who underwent CCRT or esophagectomy at Kosin University Gospel Hospital from January 2010 to December 2016. The patients’ baseline characteristics, pathology, recurrence rate, and three-year/five-year overall survival were obtained Results: This study evaluated ESCC patients with cT1-T2, N+ or cT3-T4, or N, who were treated by definitive CCRT (n=14) or esophagectomy (n=32). No significant difference was noted between the two groups, except for the location of the cancer and performance state. The respective three- and five-year overall survival rates were 30.8% and 23.1% in the CCRT group and 40.2% and 22.5% in the esophagectomy group (p=0.685). In the CCRT group, three patients (21.4%) had a complete response, and two (66.7%) had a recurrence. In the esophagectomy group, an R0 resection was achieved in 28 (87.5%) patients, and a recurrence occurred in 18 (64.3%). The median disease-free survival in the CCRT and esophagectomy groups was 14 and 17 months, respectively (p=0.882).
Conclusions
These results showed no significant difference in survival between the definitive CCRT and surgery as the initial treatment. Nevertheless, larger prospective studies will be needed because of the retrospective nature and small number of patients in this study.

Keyword

Esophageal squamous cell carcinoma; Chemoradiotherapy; Esophagectomy

Figure

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  Fig. 1 Diagram depicting the flow of patients in the study. CTx, chemotherapy; RTx, radiation therapy; CCRT, concurrent chemoradiation therapy; SQCC, squamous cell carcinoma; ADC, adenocarcinoma; CR, complete remission; PR, partial remission; PD, progressive disease.

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  Fig. 2 Kaplan–Meier survival curves for the overall survival (A) in all patients, overall survival (B), and disease-free survival (C) according to the treatment modality (concurrent chemoradiotherapy and surgery).

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  Fig. 3 Comparison of clinical with pathological lymph nodal staging.

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