%0 Journal Article
%T Role of the modern radiotherapy in the postoperative setting for esophageal cancer
%A Francesco Cellini
%A Gian-Carlo Mattiucci
%J SCIE-indexed Journal
%D 2017
%R 10.21037/jtd.2017.10.07
%X Hwang and colleagues recently reported on a propensity score matched (PSM) analysis to evaluate the role of adjuvant radiochemotherapy (RTCT) in esophageal cancer (1). They collected data from 1,095 esophageal squamous cell carcinoma (ESCC) patients. The investigated population both included patients who only underwent to surgery (group 1; 679 patients) and having also received adjuvant RTCT (group 2; 416 patients). The data about patients have been obtained from the Taiwan Cancer Registry database. Finally, 147 balanced patients per group were selected by PSM. The 3-year survival rate was 28.1% in group 1 and 44.9% in group 2, respectively. Interestingly, the multivariate analysis highlighted some factors resulted statistically significant predictors for clinical outcome: postoperative T3 and T4 (pT3/4) [hazard ratio (HR): 2.03, 95% CI: 1.38每2.97, P<0.001], postoperative positive lymph-nodes (pN+) (HR: 1.83, 95% CI: 1.31每2.57, P=ˋ0.0004), tumor length over than 32 mm (HR: 1.93, 95% CI: 1.33每2.79, P<0.001), evidence of either microscopical or macroscopical residual (R1 or R2) at resection (HR: 1.75, 95% CI: 1.15每2.66, P=0.009), and administration of adjuvant RTCT (HR: 0.57, 95% CI: 0.42每0.78, P<0.0001). Looking at the patient＊s characteristics, patients analyzed in group 2 were younger and presenting more advanced tumors compared with group 1. Moreover in the group 2 there were more: T3 and T4 tumors (77.6% vs. 28.6%), N+ tumors (76.8% vs. 20.3%), M1 tumors (6.3% vs. 2.4%), stage III/IV tumors (68.5% vs. 15.9%), large-sized tumors (45.6 vs. 30.9 mm) and poorly differentiated tumors (32.6% vs. 23.4%). The rate of residual tumor at resection margin (R1/2 resection) was also higher in the group 2 (18.6% vs. 6.9%). Authors＊ report that around 45% of the presentations were preoperatively sited in lower esophagus in both groups, but do not specifically account for the junctional presentations. We could summarize that such evidence suggests how postoperative RTCT seems able to compensate for adverse features individuated after surgery, including pT3/4, pN+, more extended tumor length, R1/2, more advanced histological grade. First of all, looking at the presented paper, the reproducibility of the results for all the patients could be questioned since derived from an Eastern population. The issue must be taken in consideration but the presented results are also in line with a previously published experience by Rice and colleagues, highlighting the advantage by administration of adjuvant RTCT over surgery alone in a smaller single-center Western population
%U http://jtd.amegroups.com/article/view/16611/html