Copyright
©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Difference in failure patterns of pT3-4N0-3M0 esophageal cancer treated by surgery vs surgery plus radiotherapy
Ya Zeng, Wen Yu, Qi Liu, Wei-Wei Yu, Zheng-Fei Zhu, Wei-Xin Zhao, Jun Liu, Jia-Ming Wang, Xiao-Long Fu, Yuan Liu, Xu-Wei Cai
Ya Zeng, Wen Yu, Jun Liu, Jia-Ming Wang, Xiao-Long Fu, Xu-Wei Cai, Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Wen Yu, Qi Liu, Wei-Wei Yu, Zheng-Fei Zhu, Wei-Xin Zhao, Xiao-Long Fu, Xu-Wei Cai, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200030, China
Wei-Wei Yu, Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Shanghai Sixth People’s Hospital, Shanghai 200030, China
Yuan Liu, Department of Statistics, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Author contributions: All authors participated in this research; Zeng Y and Cai XW contributed to manuscript writing, patient collection, and data analysis; Yu W, Yu WW, Liu Qi, Wang JM, Liu J, Zhu ZF, and Zhao WX contributed to patient collection and follow-up visit; Fu XL and Cai XW contributed to patient collection and research design; and Liu Y reviewed the statistical methods of this study.
Supported by Emerging Advanced Technology Joint Research Project of Shanghai Shenkang Hospital Development Center, No. SHDC12017103; and Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support, No. 20161433.
Institutional review board statement: Approval was achieved from the Institute Research Ethics Committee of Shanghai Chest Hospital and Shanghai Cancer Center before the patients were enrolled in the relevant studies. So, there was no additional approval for this study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xu-Wei Cai, MD, PhD, Chief Doctor, Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China. cxw1802@shchest.org
Telephone: +86-18916273163
Received: April 26, 2019
Peer-review started: May 9, 2019
First decision: July 31, 2019
Revised: August 8, 2019
Accepted: September 10, 2019
Article in press: September 10, 2019
Published online: December 15, 2019
ARTICLE HIGHLIGHTS
Research background
Postoperative radiotherapy (PORT) could improve the local control of stage T3-4 or lymph node positive esophageal squamous cell carcinoma (ESCC) patients. There was no study comparing the difference of failure patterns after surgery with or without PORT in such patients.
Research motivation
We wanted to investigate the difference of failure patterns in order to guide the following treatment for patients suffering treatment relapse.
Research objectives
To define the difference between patients with stage pT3-4N0-3M0 ESCC with or without PORT after esophagectomy.
Research methods
Patients with pathologically stage T3-4 ESCC who receive PORT after surgery were included in an S + R arm, and the others without PORT were included in an S arm. This study mainly investigated the difference of failure patterns between the two arms.
Research results
This study reported that PORT could decrease locoregional relapse. However, the proportion of distant metastasis in the S + R arm was much more than that in the S arm.
Research conclusions
PORT could improve the local control for patients with stage pT3-4 ESCC. Further studies need to be conducted to control hematogenous metastasis.
Research perspectives
The treatment of locally advanced ESCC is a hot topic. PORT could decrease locoregional lymph node relapse, but distant metastasis after PORT is the main reason that results in treatment failure. It is urgent to find an effective treatment to control this situation. And now we should explain the main failure patterns after undergoing different treatment strategies.
