Table 4.
Outcomes of studies on salvage surgery following definitive chemoradiation therapy in esophageal cancer
| Study | Study type | No. of patientsa) | Histology | Chemotherapy | Radiation dose (Gy) | Salvage indicationsb) | Surgery | Outcomes | |
|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||
| After diagnosis/enrollment | After surgery | ||||||||
| This study | Retrospective cohort | 105 (192) | SCC (95); AC (7); others (3) | Primary PFL | 50.4 | RES (pathology proved) (105) | E (85.7% R0) | 1-year OS (89.3%); 3-year OS (54.8%); mOS (40 m) | 1-year OS (79.8%); 3-year OS (49.6%); mOS (35 m); 1-year RFS (61.6%); 3-year RFS (33.6%); mRFS (20 m) |
| RTOG 0246 | Clinical trial (dCRT +-S) | 17 (41) | SCC/AC | PPF | 50.4 | RES (17) | SE | 1-year OS (88.2%); 3-year OS (47.1%) | NA |
| Markar et al. [6] | Retrospective cohort (nCRT +S vs. dCRT +S) | 234 (308) | SCC (144); AC (85); others (5) | FP | 50 (range, 25–75) | RES (234) | SE (86.3% R0) | NA | 3-year OS (39.1%); 3-year DFS (35.4%) |
| Miyata et al. [13] | Retrospective cohort (dCRT +S) | 116 (227) | SCC (116) | FP; TF | 56.8±5.6 | RES (116) | SE (83% R0) | NA | 3-year OS (33.7%); 5-year OS (28.0%) |
| Watanabe et al. [24] | Retrospective cohort (dCRT +S) | 43 (63) | SCC (63) | FP (51); nil (12) | 60 (range, 50–70) | RES (43); REC (20) | SE (73% R0) | NA | 3-year OS (29.8%); 5-year OS (15.0%) |
| JCOG0909 [7] | Clinical trial (dCRT +-S) | 12 (25) | SCC (25) | FP | 50.4 | RES (13); REC (12) | SE (21 [76% R0]); lymphadenectomy (4) | NA | 1-year OS (72%); 3-year OS (33.5%); 5-year OS (22.3%); OS (2.4 yr) |
| JCOG9906 [12] | Clinical trial (dCRT +-S) | 4 (11) | SCC (11) | FP | 60 | RES (4); REC (7) | SE (10 [70% R0]); no resection (1) | 3-year OS (40%); mOS (16.7 m) | NA |
| NEEDS [11] (ongoing) | Clinical trial (nCRT +S vs. dCRT +-S) | NA (600) | SCC (600) | TC; FP; FOLFOX | 50–50.4 | RES (NA); REC (NA) | SE | NA | NA |
| Marks et al. [25] | Retrospective cohort (nCRT +S vs. dCRT +S) | 9 (65) | AC (65) | NA | 50±4 | RES (9); REC (56) | SE (90.8% R0) | NA | 3y-OS (48%); 5-year OS (32%); mOS (32 m) |
Chemotherapy regimens: FP, 5-fluorouracil + cisplatin; PFL, cisplatin + 5-fluorouracil + leucovorin; PPF, paclitaxel + cisplatin + 5-fluorouracil; TC, paclitaxel + carboplatin; TF, docetaxel + 5-fluorouracil.
SCC, squamous cell carcinoma; AC, adenocarcinoma; RES, residual; E, esophagectomy; OS, overall survival; mOS, median overall survival; RFS, recurrence-free survival; mRFS, median recurrence-free survival; dCRT, definitive chemoradiotherapy; S, surgery; SE, salvage esophagectomy; NA, not available; nCRT, neoadjuvant chemoradiation therapy; DFS, disease-free survival; REC, recurrence.
a)The numbers represent the number of patients who underwent surgery for residual tumors (all patients in the study). The numbers in bold indicate the total number of patients included in the outcome analysis. b)Salvage indications for patients assessed in the outcome analysis.