Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer

Changhoon Yoo, Ji Hyun Park, Dok Hyun Yoon, Seung Il Park, Hyeong Ryul Kim, Jong Hoon Kim, Hwoon Yong Jung, Gin Hyug Lee, Kee Don Choi, Ho June Song, Ho Young Song, Ji Hoon Shin, Kyung Ja Cho, Yong Hee Kim, Sung Bae Kim

Research output: Contribution to journalArticle

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Abstract

Background: Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. Methods: Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials. Results: The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42%), and anastomotic leakage occurred in 1 patient (8%). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58%. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p = 0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p < 0.001). Conclusions: While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.

Original languageEnglish (US)
Pages (from-to)1862-1868
Number of pages7
JournalAnnals of Thoracic Surgery
Volume94
Issue number6
DOIs
StatePublished - Dec 1 2012

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Esophagectomy
Chemoradiotherapy
Esophageal Neoplasms
Survival
Salvage Therapy
Anastomotic Leak
Treatment Failure
Disease-Free Survival
Squamous Cell Carcinoma
Radiotherapy
Survival Rate
Demography
Radiation
Morbidity
Safety
Drug Therapy
Lung

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Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer. / Yoo, Changhoon; Park, Ji Hyun; Yoon, Dok Hyun; Park, Seung Il; Kim, Hyeong Ryul; Kim, Jong Hoon; Jung, Hwoon Yong; Lee, Gin Hyug; Choi, Kee Don; Song, Ho June; Song, Ho Young; Shin, Ji Hoon; Cho, Kyung Ja; Kim, Yong Hee; Kim, Sung Bae.

In: Annals of Thoracic Surgery, Vol. 94, No. 6, 01.12.2012, p. 1862-1868.

Research output: Contribution to journalArticle

Yoo, C, Park, JH, Yoon, DH, Park, SI, Kim, HR, Kim, JH, Jung, HY, Lee, GH, Choi, KD, Song, HJ, Song, HY, Shin, JH, Cho, KJ, Kim, YH & Kim, SB 2012, 'Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer', Annals of Thoracic Surgery, vol. 94, no. 6, pp. 1862-1868. https://doi.org/10.1016/j.athoracsur.2012.07.042
Yoo, Changhoon ; Park, Ji Hyun ; Yoon, Dok Hyun ; Park, Seung Il ; Kim, Hyeong Ryul ; Kim, Jong Hoon ; Jung, Hwoon Yong ; Lee, Gin Hyug ; Choi, Kee Don ; Song, Ho June ; Song, Ho Young ; Shin, Ji Hoon ; Cho, Kyung Ja ; Kim, Yong Hee ; Kim, Sung Bae. / Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer. In: Annals of Thoracic Surgery. 2012 ; Vol. 94, No. 6. pp. 1862-1868.
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abstract = "Background: Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. Methods: Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials. Results: The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42{\%}), and anastomotic leakage occurred in 1 patient (8{\%}). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58{\%}. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p = 0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p < 0.001). Conclusions: While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.",
author = "Changhoon Yoo and Park, {Ji Hyun} and Yoon, {Dok Hyun} and Park, {Seung Il} and Kim, {Hyeong Ryul} and Kim, {Jong Hoon} and Jung, {Hwoon Yong} and Lee, {Gin Hyug} and Choi, {Kee Don} and Song, {Ho June} and Song, {Ho Young} and Shin, {Ji Hoon} and Cho, {Kyung Ja} and Kim, {Yong Hee} and Kim, {Sung Bae}",
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T1 - Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer

AU - Yoo, Changhoon

AU - Park, Ji Hyun

AU - Yoon, Dok Hyun

AU - Park, Seung Il

AU - Kim, Hyeong Ryul

AU - Kim, Jong Hoon

AU - Jung, Hwoon Yong

AU - Lee, Gin Hyug

AU - Choi, Kee Don

AU - Song, Ho June

AU - Song, Ho Young

AU - Shin, Ji Hoon

AU - Cho, Kyung Ja

AU - Kim, Yong Hee

AU - Kim, Sung Bae

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background: Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. Methods: Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials. Results: The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42%), and anastomotic leakage occurred in 1 patient (8%). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58%. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p = 0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p < 0.001). Conclusions: While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.

AB - Background: Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. Methods: Twelve patients who underwent salvage esophagectomy after chemoradiotherapy between January 2003 and November 2010 were included in this retrospective analysis. Baseline demographics and survivals of these patients were compared with 21 patients who did not receive salvage esophagectomy for locoregional failure only after chemoradiotherapy, identified from our own previous prospective trials. Results: The median age was 62.5 years (range 50 to 69) and all patients had squamous cell carcinoma. The median radiation dose was 54.0 Gy (range 41.4 to 66.0) and the median interval between completion of chemoradiation and surgery was 8.0 months (range 2.0 to 32.9). There were no in-hospital deaths. Pulmonary complication was the most common postoperative morbidity (42%), and anastomotic leakage occurred in 1 patient (8%). With a median follow-up period of 29.3 months (range 5.8 to 73.0), the overall 3-year survival rate was 58%. Patients with early pathologic stage disease (T1/2 and N0) showed significantly prolonged survival (p = 0.03) compared with those with advanced pathologic stage (T3/T4 or N1). Patients with salvage esophagectomy had prolonged event-free survival and overall survival compared with those patients with locoregional failure who received primary chemotherapy or boost radiotherapy (p < 0.001). Conclusions: While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.

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