Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2 N0 esophageal cancer patients due to inaccurate preoperative staging

Abstract

Background: It remains unclear if patients with clinical stage T2 N0 (cT2 N0) esophageal cancer should be offered induction therapy vs surgical intervention alone.

Methods: This was a retrospective cohort study of cT2 N0 patients undergoing induction therapy, followed by surgical resection, or resection alone, at the Johns Hopkins Hospital from 1989 to 2009. Kaplan-Meier analysis was used to compare all-cause mortality in cT2 N0 patients who had resection alone vs those who had induction chemoradiation therapy, followed by resection.

Results: A study cohort of 69 patients was identified and divided into two groups: 55 patients (79.7%) received induction therapy and 14 (20.3%) did not. No statistically significant difference in 5-year survival rate was observed for the two groups: 49.5% for the resection-only group and 53.8% for the induction group. More than 50% of cT2 N0 patients were understaged.

Conclusions: For cT2 N0 esophageal cancer patients, the benefit of neoadjuvant therapy is still unclear. Induction therapy for cT2 N0 did not translate into a statistically significant improvement in survival. However, due to the significant understaging of T2 N0 patients, we recommend neoadjuvant therapy to all cT2N0 patients before operation.

Fig 1

Kaplan-Meier curves of overall survival rates for 14 esophageal cancer patients staged as cT2 N0 who underwent operations alone vs 55 cT2 N0 patients who received neoadjuvant chemoradiation therapy, followed by operation, with 5-year survival rates of 49.5% vs 53.8%, respectively.

Fig 2

Kaplan-Meier curves of recurrence-free survival rates for 10 esophageal cancer patients staged as cT2 N0 who underwent operations alone vs 50 cT2 N0 patients who received neoadjuvant chemoradiation therapy, followed by an operation, with 5-year recurrence-free survival rates of 80% vs 63%, respectively. This analysis excluded 7 patients who were margin-positive and 2 patients with unknown margin status.