Evaluation and treatment results of trimodality therapy for advanced esophageal squamous cell carcinoma
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ORIGINAL ARTICLE
Evaluation and treatment results of trimodality therapy for advanced esophageal squamous cell carcinoma Masao Hosokawa1 · Miyako Myojin2 · Tomohiro Kikkawa1 · Satoshi Okahara5 · Yuya Onodera3 · Toshinao Takenouchi4 · Tomoyuki Ohuchi4 Received: 15 June 2020 / Accepted: 30 August 2020 © The Japan Esophageal Society 2020
Abstract Objectives The prognosis for highly advanced esophageal squamous cell carcinoma (ESCC) remains poor, and there is currently no standard treatment. The purpose of this study was to examine the benefits of trimodality therapy [chemoradiation plus surgery, (CRT + S)] by evaluating the surgical outcomes of patients with ESCC in Keiyukai Sapporo Hospital, Japan. We assessed the preoperative and postoperative adverse events, treatment effects of preoperative CRT, metastatic diagnosis of the dissected lymph nodes, and survival. Patients and methods Between 2012 and 2018, 148 patients with highly advanced ESCC who underwent preoperative CRT + S were analyzed for diagnosis and staging, preoperative complications, clinical and histopathological effects of CRT in the resected specimens, survival rates, and recurrences. Results The grade 3 and higher complications of preoperative CRT were neutropenia in 3 cases and thrombocytopenia in 1 case. Among the postoperative complications, there were 2 cases (1.4%) of direct surgical death, only tracheobronchial bleeding and liver failure. Using the 11th edition of the classification of esophageal cancer by the Japanese Esophageal Society, 60 patients (40.5%) were classified as grade 3 (negative for cancer cells, pathological complete response). However, 20 of them (33.3%) had metastatic tumor cells in the lymph nodes. The overall 5-year survival rate was 58.5%. Including references to the pathological findings and recurrence patterns, there is no effective diagnostic method for selecting the subsequent approach based on the effectiveness of CRT. Conclusion Planned surgery following CRT was the only solution for achieving better treatment results. CRT + S is a promising treatment with low direct surgical mortality. Keywords Preoperative chemoradiation · Esophageal squamous cell carcinoma · Trimodality therapy · Planned operation
Introduction
* Masao Hosokawa [email protected] 1
Department of Surgery, Keiyukai Sapporo Hospital, Kita1‑1, Hondori14‑chome, Shiroishi‑ku, Sapporo, Hokkaido 003‑0027, Japan
2
Department of Radiation Oncology, Keiyukai Sapporo Hosopital, Sapporo, Hokkaido, Japan
3
Department of Radiology, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
4
Department of Pathology, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
5
Department of Gastroenterology, Keiyukai Second Hospital, Sapporo, Hokkaido, Japan
The treatment outcomes of esophageal cancer patients have been improved by early detection. These treatments tend to focus more on surgical techniques and minimally invasive approaches rather than curative ones. However, it is still difficult to select a treatment method for highly
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