Management of Clinical T1N0M0 Esophageal Cancer

Abstract

Background/aims: Endoscopic resection is a standard treatment for stage T1a esophageal cancer, with esophagectomy or radical radiation therapy (RT) performed for stage T1b lesions. This study aimed to compare treatment outcomes of each modality for clinical stage T1 esophageal cancer.

Methods: In total, 179 patients with clinical T1N0M0-stage esophageal cancer treated from 2006 to 2016 were retrospectively evaluated. Sixty-two patients with clinical T1a-stage cancer underwent endoscopic resection. Among 117 patients with clinical T1b-stage cancer, 82 underwent esophagectomy, and 35 received chemoradiotherapy or RT. We compared overall survival (OS) and recurrence-free survival (RFS) rates for each treatment modality.

Results: The median follow-up time was 32 months (range, 1 to 120 months). The 5-year OS and RFS rates for patients with stage T1a cancer receiving endoscopic resection were 100% and 85%, respectively. For patients with stage T1b, the 5-year OS and RFS rates were 78% and 77%, respectively, for the esophagectomy group; 80% and 44%, respectively, for the RT alone group; and 96% and 80%, respectively, for the chemoradiation group. The esophagectomy group showed significantly higher RFS than the RT alone group (p=0.04). There was no significant difference in RFS between the esophagectomy and chemoradiation groups (p=0.922). Grade 4 or higher treatment-related complications occurred in four patients who underwent esophagectomy.

Conclusions: Endoscopic resection appeared to be an adequate treatment for patients with T1a-stage esophageal cancer. The multidisciplinary approach involving chemoradiation was comparable to esophagectomy in terms of survival outcome without serious complications for T1b-stage esophageal cancer.

Keywords: Chemoradiotherapy; Endoscopic mucosal resection; Esophageal neoplasm; Esophagectomy; Radiotherapy.

Fig. 1

Treatment flow of all patients (n=179). cT, clinical T stage; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal resection; CCRT, concurrent chemoradiotherapy; RT, radiation therapy; pT, pathologic T stage; Tx, therapy.

Fig. 2

Comparison of Kaplan-Meier overall survival (OS) curves; (A) OS and recurrence-free survival (RFS) of all patients, (B) OS and RFS of patients with cT1a lesions after endoscopic resection, (C) OS and (D) RFS of patients with cT1b lesions according to the treatment group. CCRT, concurrent chemoradiotherapy; RT, radiotherapy.

Fig. 3

Flow of treatment outcomes for each treatment group. Outcome for endoscopic therapy group (A), esophagectomy group (B), concurrent chemoradiotherapy (CCRT) group (C), radiotherapy (RT) group (D). EMR, endoscopic mucosal resection; ESD, endoscopic submucosal resection; CR, complete response; NED, no evidence of disease; PR, partial response.

Fig. 3

Flow of treatment outcomes for each treatment group. Outcome for endoscopic therapy group (A), esophagectomy group (B), concurrent chemoradiotherapy (CCRT) group (C), radiotherapy (RT) group (D). EMR, endoscopic mucosal resection; ESD, endoscopic submucosal resection; CR, complete response; NED, no evidence of disease; PR, partial response.