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Optimal Adjuvant Treatment for Curatively Resected Thoracic Esophageal Squamous Cell Carcinoma: A Radiotherapy Perspective

 Kyung Hwan Kim  ;  Jee Suk Chang  ;  Ji Hye Cha  ;  Ik Jae Lee  ;  Dae Joon Kim  ;  Byoung Chul Cho  ;  Kyung Ran Park  ;  Chang Geol Lee 
 CANCER RESEARCH AND TREATMENT, Vol.49(1) : 168-177, 2017 
Journal Title
Issue Date
Adult ; Aged ; Biopsy ; Carcinoma, Squamous Cell/diagnosis ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/therapy* ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Esophageal Neoplasms/diagnosis ; Esophageal Neoplasms/mortality ; Esophageal Neoplasms/therapy* ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multimodal Imaging/methods ; Neoplasm Grading ; Neoplasm Metastasis ; Neoplasm Staging ; Radiotherapy, Adjuvant/methods ; Recurrence ; Retreatment ; Survival Analysis ; Treatment Outcome
Drug therapy ; Esophageal neoplasms ; Radiotherapy ; Squamous cell carcinoma
PURPOSE: The purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments.

MATERIALS AND METHODS: One hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated.

RESULTS: At a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups.

CONCLUSION: Adjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dae Joon(김대준)
Lee, Ik Jae(이익재) ORCID logo https://orcid.org/0000-0001-7165-3373
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Cho, Byoung Chul(조병철) ORCID logo https://orcid.org/0000-0002-5562-270X
Cha, Ji Hye(차지혜)
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