Management of clinical T1N0M0 stage esophageal cancer

Abstract

Purpose: Endoscopic resection is employed as a standard treatment for stage T1a esophageal cancer, and esophagectomy or radical radiation therapy (RT) are used for stage T1b lesion. The purpose of this study was to compare treatment outcomes of each modality with clinical stage T1 esophageal cancer. Materials and Methods: A total of 179 patients with clinical T1N0M0 stage esophageal cancer treated during 2006 and 2016 were retrospectively evaluated. Sixty-two patients with clinical T1a stage underwent endoscopic resection. Among 117 patients with clinical T1b stage, 82 patients underwent esophagectomy, and 35 patients received chemoradiotherapy or RT. We compared overall survival (OS) and recurrence-free survival (RFS) rates by each treatment modality. Results: Median follow-up time was 32 months (range, 1 - 120 months). The 5-year OS and RFS rate for patients with stage T1a receiving endoscopic resection was 100% and 85%, respectively. For patients with stage T1b, the 5-year OS and RFS rate was 78% and 77% for the esophagectomy group and 80% and 44% for the RT alone group and 96% and 80% for the chemoradiation group, respectively. The esophagectomy group showed significantly higher RFS than RT alone group (p=0.04). There was no significant difference in RFS between the esophagectomy and the chemoradiation group (p=0.922). Grade 3 or higher treatment-related complication occurred in 4 patients who received esophagectomy. Conclusion: The endoscopic resection alone appeared as adequate treatment for patients with T1a stage esophageal cancer. Definitive chemoradiation was comparable to esophagectomy in survival outcome without serious complication for T1b stage esophageal cancer.