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Clinical Outcomes of Neoadjuvant Treatment in Advanced Esophageal Cancer.
Woohyun Jung, Kwanyoung Hyun, Saemina Park, In Kyu Park, Young Tae Kim, Chang Hyun Kang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
Purpose : We evaluated the clinical outcomes of neoadjuvant chemoradiotherapy followed by surgery in esophageal cancer patients
Methods : From Jan 2010 to Mar 2017, we enrolled and analyzed 106 patients: 98% of patients had squamous-cell carcinoma, 2% had adenocarcinoma. All patients received administration of 5-FU + cisplatin or paclitaxel + carboplatin and concurrent radiotherapy (45 Gy in 25 fractions, 5 days per week on tumor and metastatic LNs), followed by esophagectomy and 2- or 3-filed LND after 4 to 6 weeks.
Results : There was one operative mortality and postoperative complications occurred in 41% of patients, including vocal cord palsy (24%), thoracic duct injury (16%), pneumonia (8%), and anastomotic leakage (8%). A pathological complete response was achieved in 29%. Complete resection with no tumor within 1 mm of the resection margins (R0) was achieved in 93% of patients. 3-filed LND was accomplished in 41% and a number of retrieved LNs was 47.34 ± 20.71. Median survival was 44.6 months and 5-year survival was 41.3%. The number of retrieved LN was associated with the survival.
Conclusion : Neoadjuvant treatment followed by surgery improves overall survival of the patients with advanced esophageal cancer. Currently neoadjuvant chemoradiation is a standard treatment as an induction treatment, however, further studies comparing with neoadjuvant chemotherapy are necessary.
Methods : From Jan 2010 to Mar 2017, we enrolled and analyzed 106 patients: 98% of patients had squamous-cell carcinoma, 2% had adenocarcinoma. All patients received administration of 5-FU + cisplatin or paclitaxel + carboplatin and concurrent radiotherapy (45 Gy in 25 fractions, 5 days per week on tumor and metastatic LNs), followed by esophagectomy and 2- or 3-filed LND after 4 to 6 weeks.
Results : There was one operative mortality and postoperative complications occurred in 41% of patients, including vocal cord palsy (24%), thoracic duct injury (16%), pneumonia (8%), and anastomotic leakage (8%). A pathological complete response was achieved in 29%. Complete resection with no tumor within 1 mm of the resection margins (R0) was achieved in 93% of patients. 3-filed LND was accomplished in 41% and a number of retrieved LNs was 47.34 ± 20.71. Median survival was 44.6 months and 5-year survival was 41.3%. The number of retrieved LN was associated with the survival.
Conclusion : Neoadjuvant treatment followed by surgery improves overall survival of the patients with advanced esophageal cancer. Currently neoadjuvant chemoradiation is a standard treatment as an induction treatment, however, further studies comparing with neoadjuvant chemotherapy are necessary.
책임저자: Chang Hyun Kang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
발표자: Woohyun Jung, E-mail : chucky0406@gmail.com