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Anticancer Res. 2019 Sep;39(9):5123-5133. doi: 10.21873/anticanres.13707.

A Randomized Phase III Trial on the Role of Esophagectomy in Complete Responders to Preoperative Chemoradiotherapy for Esophageal Squamous Cell Carcinoma (ESOPRESSO).

Author information

1
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
2
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
3
Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
4
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
5
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
6
Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
7
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
8
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea sbkim3@amc.seoul.kr.

Abstract

BACKGROUND/AIM:

We investigated the role of esophagectomy after clinical complete response (cCR) to chemoradiotherapy for esophageal squamous cell carcinoma (ESCC).

PATIENTS AND METHODS:

Patients with resectable cT3-T4a/anyN/M0 or anyT/N+/M0 thoracic ESCC received two cycles of induction chemotherapy and then chemoradiotherapy (50.4 Gy/28 fractions). Patients with cCR were randomized to surgery or observation.

RESULTS:

Among 86 patients, 38 (44.2%) achieved cCR after chemoradiotherapy; 37 were randomized to surgery (n=19) or observation (n=18). Although there were trends of better disease-free survival (DFS) toward the surgery arm in the intent-to-treat analysis (2-year DFS, 66.7% vs. 42.7%; p=0.262) or as-treated analysis (66.7% vs. 50.2%; p=0.273), overall survival was not different between the two arms in the intent-to-treat (HR=1.48; p=0.560) or as-treated analysis (HR=1.09; p=0.903). Among the 11 patients having recurrence during observation, 8 underwent surgery (n=7) or endoscopic dissection (n=1).

CONCLUSION:

Close observation with salvage surgery might be a reasonable option in resectable ESCC patients achieving cCR after chemoradiation.

KEYWORDS:

Esophageal squamous cell carcinoma; chemoradiotherapy; clinical complete response; induction chemotherapy; observation; surgery

PMID:
31519624
DOI:
10.21873/anticanres.13707
[Indexed for MEDLINE]

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