Outcomes from salvage esophagectomy post definitive chemoradiotherapy compared with resection following preoperative neoadjuvant chemoradiotherapy

Smithers, B. M., Cullinan, M., Thomas, J. M., Martin, I., Barbour, A. P., Burmeister, B. H., Harvey, J. A., Thomson, D. B., Walpole, E. T. and Gotley, D. C. (2007) Outcomes from salvage esophagectomy post definitive chemoradiotherapy compared with resection following preoperative neoadjuvant chemoradiotherapy. Diseases of The Esophagus, 20 6: 471-477. doi:10.1111/j.1442-2050.2007.00701.x


Author Smithers, B. M.
Cullinan, M.
Thomas, J. M.
Martin, I.
Barbour, A. P.
Burmeister, B. H.
Harvey, J. A.
Thomson, D. B.
Walpole, E. T.
Gotley, D. C.
Title Outcomes from salvage esophagectomy post definitive chemoradiotherapy compared with resection following preoperative neoadjuvant chemoradiotherapy
Journal name Diseases of The Esophagus   Check publisher's open access policy
ISSN 1120-8694
Publication date 2007-01-01
Sub-type Article (original research)
DOI 10.1111/j.1442-2050.2007.00701.x
Volume 20
Issue 6
Start page 471
End page 477
Total pages 7
Place of publication Oxford
Publisher Blackwell Publishing
Collection year 2008
Language eng
Subject 321015 Oncology and Carcinogenesis
321023 Radiotherapy and Nuclear Medicine
321029 Surgery
C1
730108 Cancer and related disorders
730109 Surgical methods and procedures
Abstract Chemoradiotherapy (CRT) as a definitive treatment for esophageal cancer, is being used with increasing frequency and as a result, surgeons will be required to assess more patients who have residual or recurrent local malignancy. This article aimed to assess outcomes after esophagectomy following definitive CRT (dCRT) and compare any difference between them and patients who had preoperative neoadjuvant CRT (nCRT) using a similar regimen of chemotherapy. From a prospective database the details of patients who had a resection following nCRT and dCRT were analyzed. The main therapeutic difference between the groups was the dose of radiotherapy (35 vs 60 Gy) and the timing of the resection following completion of the CRT (median 4 vs 28 weeks). Fourteen patients had an esophagectomy following a dCRT and 53 had one following a nCRT. Preoperatively, the dCRT group had worse respiratory function and more ECG abnormalities. Preoperative tumor length, pathological TNM staging and R0 resection rates were the same in both groups. Post resection, the dCRT group had greater morbidity than the nCRT group, spending longer in the intensive care unit (median 48 vs 24 h), more days in hospital (median 31 vs 13) and having more severe respiratory complications (37% vs 6%). The operative mortality was higher in the dCRT group (7% vs 0%). The three-year survival was 24% after dCRT. Patients selected for salvage esophagectomy following dCRT are a major challenge in postoperative care. However, some patients survive for a reasonable period of time, making resection a worthwhile option.
Keyword Gastroenterology & Hepatology
definitive chemoradiotherapy
esophageal neoplasm
neoadjuvant chemoradiotherapy
postoperative morbidity
salvage esophagectomy
Squamous-cell Cancer
Esophagus
Chemotherapy
Radiotherapy
Carcinoma
Trial
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2008 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Tue, 19 Feb 2008, 01:26:00 EST