Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

Çağkan Ergiden; İpek Pınar Aral; Gonca Altınışık İnan; Sedef Gökhan Açıkgöz; Hamza Onur Sarpkaya; Havva Beyaz; Hüseyin Furkan Öztürk; Suheyla Aytaç Arslan; Muhammed Bülent Akıncı; Yılmaz Tezcan

Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma

Abstract

INTRODUCTION: It aimed to evaluate the overall survival (OS) results of chemoradiotherapy (CRT) without surgery in patients with locally advanced esophageal squamous cell carcinoma (ESCC). METHODS: Patients who received chemoradiotherapy with a diagnosis of ESCC at the Radiation Oncology Department of Ankara Bilkent City Hospitals were retrospectively analysed. The primary endpoint was OS. RESULTS: The results of 46 patients who underwent radiotherapy (RT) between 26.06.2012 and 21.03.2023 were analysed. Median follow-up was 14 (range 1-47) months. The localisation was upper thoracic in 8(17.4%), middle thoracic in 36(78.3%) and lower thoracic in 2(4.3%) patients. Surgery was considered at the time of admission to the radiotherapy clinic in 25 (54.3%) of our patient group, and neoadjuvant treatment was given, but no surgery was subsequently performed. Patients referred to the radiotherapy clinic for neoadjuvant chemoradiotherapy received a significantly lower total dose than those referred directly for definitive chemoradiotherapy (p0.006; Z-2.768). Patients were evaluated by endoscopic biopsy and computed tomography 6-8 weeks after the end of treatment, and clinical complete response (cCR) was observed in 15 (32.6%) patients. At last follow-up, 19 (41.3%) patients were dead and 27 (58.7%) were alive. Median OS was 25 months (range 1.5-47). 1-year OS was 66%; 2-year OS was 54.7%; 3-year OS was 40.4%. Significantly higher OS was observed in patients with cCR (HR 4.2; 95% CI 1.2-14.7). DISCUSSION AND CONCLUSION: Patients referred to the radiotherapy clinic for neoadjuvant therapy received a significantly lower total dose than patients referred for definitive chemoradiotherapy. Patients who received cCR after chemoradiotherapy had significantly higher OS.

Keywords

References

1. Huang, Junjie, et al. "Global burden, risk factors, and trends of esophageal cancer: an analysis of cancer registries from 48 countries." Cancers 13.1 (2021): 141.
2. Vellayappan, Balamurugan A., et al. "Chemoradiotherapy versus chemoradiotherapy plus surgery for esophageal cancer." Cochrane Database of Systematic Reviews 8 (2017).
3. Oh, Dongryul, and Jong Hoon Kim. "The current evidence on neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma." The Korean Journal of Thoracic and Cardiovascular Surgery 53.4 (2020): 160.
4. Lu, Ching-Liang, et al. "Increasing trend of the incidence of esophageal squamous cell carcinoma, but not adenocarcinoma, in Taiwan." Cancer causes & control 21 (2010): 269-274.
5. Obermannová, Radka, et al. "Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up☆." Annals of Oncology 33.10 (2022): 992-1004.
6. Ajani, Jaffer A., et al. "Esophageal and Esophagogastric Junction Cancers, Version 2.2023, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network 21.4 (2023): 393-422.
7. Boshier, Piers R., et al. "Assessment of health related quality of life and digestive symptoms in long-term, disease free survivors after esophagectomy." Annals of Surgery 275.1 (2022): e140-e147.
8. Park, Jaehyeon, et al. "Omitting surgery in esophageal cancer patients with complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis." Radiation Oncology 16.1 (2021): 1-10.

9. Wang J, Qin J, Jing S, Liu Q, Cheng Y, Wang Y, Cao F. Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta-analysis. Thorac Cancer. 2018 Dec;9(12):1638-1647. doi: 10.1111/1759-7714.12874. Epub 2018 Oct 1. PMID: 30277016; PMCID: PMC6275815.
10. Eisenhauer, Elizabeth A., et al. "New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)." European journal of cancer 45.2 (2009): 228-247.
11. Stahl, Michael, et al. "Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus." Journal of clinical oncology 23.10 (2005): 2310-2317.
12. Bedenne, Laurent, et al. "Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102." Journal of clinical oncology 25.10 (2007): 1160-1168.
13. Crosby T, Hurt CN, Falk S, Gollins S, Staffurth J, Ray R, Bridgewater JA, Geh JI, Cunningham D, Blazeby J, Roy R, Maughan T, Griffiths G, Mukherjee S. Long-term results and recurrence patterns from SCOPE-1: a phase II/III randomised trial of definitive chemoradiotherapy +/- cetuximab in oesophageal cancer. Br J Cancer. 2017 Mar 14;116(6):709-716. doi: 10.1038/bjc.2017.21. Epub 2017 Feb 14. PMID: 28196063; PMCID: PMC5355926.
14. Van Der Wilk, Berend J., et al. "Chemoradiotherapy followed by active surveillance versus standard esophagectomy for esophageal cancer: a systematic review and individual patient data meta-analysis." Annals of surgery 275.3 (2022): 467-476.
15. Best, Lawrence MJ, Muntzer Mughal, and Kurinchi Selvan Gurusamy. "Non‐surgical versus surgical treatment for oesophageal cancer." Cochrane Database of Systematic Reviews 3 (2016).
16. Chow, Ronald, et al. "Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy and esophagectomy for the treatment of esophageal and gastroesophageal carcinoma–a systematic review and meta-analysis." Radiotherapy and Oncology 165 (2021): 37-43.
17. van Hagen, Pieter, et al. "Preoperative chemoradiotherapy for esophageal or junctional cancer." New England Journal of Medicine 366.22 (2012): 2074-2084.
18. Minsky, Bruce D., et al. "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." Journal of clinical oncology 20.5 (2002): 1167-1174.
19. Hulshof, Maarten CCM, et al. "Randomized study on dose escalation in definitive chemoradiation for patients with locally advanced esophageal cancer (ARTDECO study)." Journal of Clinical Oncology 39.25 (2021): 2816-2824.
20. Reynolds JV, Preston SR, O'Neill B, Baeksgaard L, Griffin SM, Mariette C, Cuffe S, Cunningham M, Crosby T, Parker I, Hofland K, Hanna G, Svendsen LB, Donohoe CL, Muldoon C, O'Toole D, Johnson C, Ravi N, Jones G, Corkhill AK, Illsley M, Mellor J, Lee K, Dib M, Marchesin V, Cunnane M, Scott K, Lawner P, Warren S, O'Reilly S, O'Dowd G, Leonard G, Hennessy B, Dermott RM. ICORG 10-14: NEOadjuvant trial in Adenocarcinoma of the oEsophagus and oesophagoGastric junction International Study (Neo-AEGIS). BMC Cancer. 2017 Jun 3;17(1):401. doi: 10.1186/s12885-017-3386-2. PMID: 28578652; PMCID: PMC5457631.
21. Hoeppner J, Lordick F, Brunner T, Glatz T, Bronsert P, Röthling N, Schmoor C, Lorenz D, Ell C, Hopt UT, Siewert JR. ESOPEC: prospective randomized controlled multicenter phase III trial comparing perioperative chemotherapy (FLOT protocol) to neoadjuvant chemoradiation (CROSS protocol) in patients with adenocarcinoma of the esophagus (NCT02509286). BMC Cancer. 2016 Jul 19;16:503. doi: 10.1186/s12885-016-2564-y. PMID: 27435280; PMCID: PMC4952147.
22. Tepper, Joel, et al. "Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781." Journal of clinical oncology: official journal of the American Society of Clinical Oncology 26.7 (2008): 1086.
23. Conroy T, Galais MP, Raoul JL, Bouché O, Gourgou-Bourgade S, Douillard JY, Etienne PL, Boige V, Martel-Lafay I, Michel P, Llacer-Moscardo C, François E, Créhange G, Abdelghani MB, Juzyna B, Bedenne L, Adenis A; Fédération Francophone de Cancérologie Digestive and UNICANCER-GI Group. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): final results of a randomised, phase 2/3 trial. Lancet Oncol. 2014 Mar;15(3):305-14. doi: 10.1016/S1470-2045(14)70028-2. Epub 2014 Feb 18. Erratum in: Lancet Oncol. 2014 Dec;15(13):e587. Erratum in: Lancet Oncol. 2014 Dec;15(13):e587. PMID: 24556041.
24. Nilsson M, Olafsdottir H, Alexandersson von Döbeln G, Villegas F, Gagliardi G, Hellström M, Wang QL, Johansson H, Gebski V, Hedberg J, Klevebro F, Markar S, Smyth E, Lagergren P, Al-Haidari G, Rekstad LC, Aahlin EK, Wallner B, Edholm D, Johansson J, Szabo E, Reynolds JV, Pramesh CS, Mummudi N, Joshi A, Ferri L, Wong RK, O'Callaghan C, Lukovic J, Chan KK, Leong T, Barbour A, Smithers M, Li Y, Kang X, Kong FM, Chao YK, Crosby T, Bruns C, van Laarhoven H, van Berge Henegouwen M, van Hillegersberg R, Rosati R, Piessen G, de Manzoni G, Lordick F. Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma Versus Definitive Chemoradiotherapy With Salvage Surgery as Needed: The Study Protocol for the Randomized Controlled NEEDS Trial. Front Oncol. 2022 Jul 13;12:917961. doi: 10.3389/fonc.2022.917961. PMID: 35912196; PMCID: PMC9326032.

Details

Primary Language

English

Subjects

Health Services and Systems (Other)

Journal Section

Research Article

Authors

Çağkan Ergiden ^*
0000-0002-8732-3018
Türkiye

İpek Pınar Aral
0000-0002-4741-3609
Türkiye

Gonca Altınışık İnan
0000-0002-7385-3480
Türkiye

Sedef Gökhan Açıkgöz
0000-0002-6615-9714
Türkiye

Hamza Onur Sarpkaya This is me
0009-0006-7533-4648
Türkiye

Havva Beyaz
0000-0003-3776-0372
Türkiye

Hüseyin Furkan Öztürk
0000-0003-2227-0346
Türkiye

Suheyla Aytaç Arslan
0000-0002-6479-0051
Türkiye

Muhammed Bülent Akıncı
0000-0001-7575-9925
Türkiye

Yılmaz Tezcan
0000-0003-3698-1640
Türkiye

Publication Date

December 27, 2024

Submission Date

September 24, 2024

Acceptance Date

November 19, 2024

Published in Issue

Year 2024 Volume: 3 Number: 4

IZ

https://izlik.org/JA64EN27UJ

Cite

RIS / Bibtex

APA

Ergiden, Ç., Aral, İ. P., Altınışık İnan, G., Gökhan Açıkgöz, S., Sarpkaya, H. O., Beyaz, H., Öztürk, H. F., Aytaç Arslan, S., Akıncı, M. B., & Tezcan, Y. (2024). Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma. ACH Medical Journal, 3(4), 123-130. https://izlik.org/JA64EN27UJ

AMA

1.Ergiden Ç, Aral İP, Altınışık İnan G, et al. Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma. ACH Med J. 2024;3(4):123-130. https://izlik.org/JA64EN27UJ

Chicago

Ergiden, Çağkan, İpek Pınar Aral, Gonca Altınışık İnan, et al. 2024. “Chemoradiotherapy Results Without Surgery in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma”. ACH Medical Journal 3 (4): 123-30. https://izlik.org/JA64EN27UJ.

EndNote

Ergiden Ç, Aral İP, Altınışık İnan G, Gökhan Açıkgöz S, Sarpkaya HO, Beyaz H, Öztürk HF, Aytaç Arslan S, Akıncı MB, Tezcan Y (December 1, 2024) Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma. ACH Medical Journal 3 4 123–130.

IEEE

[1]Ç. Ergiden et al., “Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma”, ACH Med J, vol. 3, no. 4, pp. 123–130, Dec. 2024, [Online]. Available: https://izlik.org/JA64EN27UJ

ISNAD

Ergiden, Çağkan - Aral, İpek Pınar - Altınışık İnan, Gonca - Gökhan Açıkgöz, Sedef - Sarpkaya, Hamza Onur - Beyaz, Havva - Öztürk, Hüseyin Furkan - Aytaç Arslan, Suheyla - Akıncı, Muhammed Bülent - Tezcan, Yılmaz. “Chemoradiotherapy Results Without Surgery in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma”. ACH Medical Journal 3/4 (December 1, 2024): 123-130. https://izlik.org/JA64EN27UJ.

JAMA

1.Ergiden Ç, Aral İP, Altınışık İnan G, Gökhan Açıkgöz S, Sarpkaya HO, Beyaz H, Öztürk HF, Aytaç Arslan S, Akıncı MB, Tezcan Y. Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma. ACH Med J. 2024;3:123–130.

MLA

Ergiden, Çağkan, et al. “Chemoradiotherapy Results Without Surgery in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma”. ACH Medical Journal, vol. 3, no. 4, Dec. 2024, pp. 123-30, https://izlik.org/JA64EN27UJ.

Vancouver

1.Çağkan Ergiden, İpek Pınar Aral, Gonca Altınışık İnan, Sedef Gökhan Açıkgöz, Hamza Onur Sarpkaya, Havva Beyaz, Hüseyin Furkan Öztürk, Suheyla Aytaç Arslan, Muhammed Bülent Akıncı, Yılmaz Tezcan. Chemoradiotherapy Results Without Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma. ACH Med J [Internet]. 2024 Dec. 1;3(4):123-30. Available from: https://izlik.org/JA64EN27UJ