Neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma: does everyone need it?
Автор: Chichevatov D.A., Sinev E.N., Glukhov A.E., Seliverstova O.M.
Журнал: Сибирский онкологический журнал @siboncoj
Рубрика: Клинические исследования
Статья в выпуске: 2 т.23, 2024 года.
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Objective. In accordance with clinical guidelines, neoadjuvant chemoradiotherapy (nCRT) is recommended as a beneficial option for treatment of thoracic esophageal squamous cell carcinoma (TESCC). However, some studies did not demonstrate potential benefits of nCRT. In this paper we compared treatment outcomes of surgery alone with preoperative CRT followed by surgery. Material and Methods Group 1 (n=147) consisted of patients who underwent surgery alone. Group 2 (n=3,337) was formed in the framework of the present systematic review and meta-analysis (15 publications captured 20 separate subgroups for analysis). Patients of group 2 received nCRT followed by esophagectomy. Overall survival (OS) and median OS were estimated.
Squamous cell esophageal carcinoma, chemoradiation therapy, surgery
Короткий адрес: https://sciup.org/140305905
IDR: 140305905 | DOI: 10.21294/1814-4861-2024-23-2-15-25
Текст научной статьи Neoadjuvant chemoradiotherapy for thoracic esophageal squamous cell carcinoma: does everyone need it?
In accordance with national and international clinical guidelines, neoadjuvant chemoradiotherapy (nCRT) is recommended as an option to improve treatment outcomes of thoracic esophageal squamous cell carcinoma (TESCC). As this modality improves survival, it has been reviewed in many recently published papers [1–15].
Nevertheless, despite common approval of the treatment strategy, there has been some ambiguity. In particular, some studies found no survival advantage of CRT followed by surgery compared to surgery alone in subgroup analysis. For example, H. Chen et al., (2018) demonstrated “upfront” surgery inferiority (HR 1.28) only after propensity score matching but did not observe it (p=0.986) analyzing primary “intention-to-treat” groups [3]. In other publications only patients who had high grade of pathological response to CRT achieved much better survival [15]. Some histological factors may have prognostic values denoting dissimilar tumor response and respectively distinguished hazard functions in subgroups [16]. O. Wiesel et al. (2022) considered favorable pathologic response to be a predictor of improved survival. Authors found out only
49.6 % of favorable responders [17]. In this regard, comparative long-term outcomes of non-responders are suspected to be unclear.
On the other hand, neoadjuvant CRT is expected to be a more or less aggressive regimen. Many authors reported different types and grades of toxicity [4, 6, 8]. Moreover, some tumors progress during neoadjuvant treatment. Hence, intolerable toxicity and tumor progression are clear factors limiting the ability of patients to undergo scheduled surgery. Since there are losses of patients in the preoperative period, nCRT may be low-efficient or completely ineffective, it should not be considered as a mandatory treatment for all patients.
In the present paper we compared outcomes of “upfront” surgery for TESCC (group 1) with the control group of patients who underwent preoperative CRT and surgery (group 2). This control group 2 was yielded in the framework of meta-analysis.
Material and Methods
1. Patients’ characteristics
A total of 147 patients were included into this study (group 1). All these patients had TESCC and
table 1/Таблица 1
patients’ characteristicsХарактеристики пациентов
|
Characteristic (data format)/ Характеристика (формат данных) |
Group 1/Группа 1 (n=147) |
Group 2/Группа 2 (n=3,337) |
p |
|
Age (mean ± SD), years/Возраст (средний ± SD), лет |
59.4 ± 7.4 |
59.5 ± 3.1 a |
0.257 |
|
Sex ratio (females/males)/Соотношение женщин/мужчин |
0.16 |
0.18 |
0.187 |
|
Т (1 – 2 – 3 – 4) |
11 – 22 – 102 – 12 |
NA |
|
|
N (0 – 1 – 2 – 3) |
64 – 54 – 28 – 1 |
NA |
|
|
Stage (I, II, III, IV), %/Клиническая стадия (I, II, III, IV), % |
13.6 – 30.6 – 51.7 – 4.1 |
20.4 – 28.5 – 45.3 – 5.8 |
0.143 |
|
Average stage/Средняя клиническая стадия |
2.46 |
2.36 |
|
|
Grade (G)/Степень дифференцировки (G) (1 – 2 – 3) |
42 – 65 – 40 |
NA |
|
|
Residual tumor (R)/Резидуальная опухоль (R) (0 – 1 – 2) |
139 – 6 – 2 |
NA |
|
|
Dysphagia grade (none – I – II – III – IV)/ Дисфагия (нет – I – II – III – IV) |
12 – 32 – 62 – 34 – 7 |
NA |
|
|
Postsurgical radiation therapy (n, %)/ Послеоперационная лучевая терапия (n, %) |
27 (18.4 %) |
NA |
|
|
Adjuvant chemotherapy (n, %)/ Адъювантная химиотерапия (n, %) |
13 (8.8 %) |
NA |
|
|
Preoperative CRT/Предоперационная ХЛТ |
0 |
3307 |
|
|
Neoadjuvant chemotherapy/Неоадъювантная химиотерапия |
0 |
30 |
|
|
Notes: a – age was announced for only 2165 of 3337 patients; NA – not assessed; created by the authors. |
|||
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