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

Jennifer Q. Zhang, Craig M. Hooker, Malcolm V Brock, James Shin, Sue Lee, Remealle How, Noreli Franco, Helen Prevas, Alicia Hulbert, Stephen C Yang

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)429-437
Number of pages9
JournalAnnals of Thoracic Surgery
Volume93
Issue number2
DOIs
StatePublished - Feb 2012

Fingerprint

Neoadjuvant Therapy
Esophageal Neoplasms
Cohort Studies
Therapeutics
Kaplan-Meier Estimate
Survival Rate
Retrospective Studies
Survival
Mortality

Keywords

  • American Society of Anesthesiologists
  • ASA
  • CI
  • clinical stage T2 N0
  • computed tomography
  • confidence interval
  • CT
  • cT2 N0
  • endoscopic ultrasound
  • EUS
  • hazard ratio
  • HR
  • interquartile range
  • IQR
  • margin negative
  • margin positive
  • pathologic stage T2 N0
  • PET
  • positron emission tomography
  • pT2 N0
  • R0
  • R1

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2 N0 esophageal cancer patients due to inaccurate preoperative staging. / Zhang, Jennifer Q.; Hooker, Craig M.; Brock, Malcolm V; Shin, James; Lee, Sue; How, Remealle; Franco, Noreli; Prevas, Helen; Hulbert, Alicia; Yang, Stephen C.

In: Annals of Thoracic Surgery, Vol. 93, No. 2, 02.2012, p. 429-437.

Research output: Contribution to journalArticle

Zhang, Jennifer Q. ; Hooker, Craig M. ; Brock, Malcolm V ; Shin, James ; Lee, Sue ; How, Remealle ; Franco, Noreli ; Prevas, Helen ; Hulbert, Alicia ; Yang, Stephen C. / Neoadjuvant chemoradiation therapy is beneficial for clinical stage T2 N0 esophageal cancer patients due to inaccurate preoperative staging. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 2. pp. 429-437.
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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.",
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AU - How, Remealle

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AU - Prevas, Helen

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