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Article

Neoadjuvant Chemoradiotherapy Followed by Esophagectomy with Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma Patients with Clinical Stage III and with Supraclavicular Lymph Node Metastasis

1
Esophageal Surgery, Akita University Hospital, Akita 010-8543, Japan
2
Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita 010-8543, Japan
3
Department of Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita 010-8543, Japan
4
Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan
*
Author to whom correspondence should be addressed.
Academic Editor: Dechen Lin
Cancers 2021, 13(5), 983; https://doi.org/10.3390/cancers13050983
Received: 14 January 2021 / Revised: 6 February 2021 / Accepted: 20 February 2021 / Published: 26 February 2021
(This article belongs to the Special Issue Neoadjuvant- and Immuno-Therapy in Esophageal Cancer)
This study aimed to clarify the efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy with three-field lymph node (LN) dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. We observed that NACRT followed by esophagectomy with three-field lymph node dissection is feasible and offers the potential for long-term survival of these patients. It is also suggested that supraclavicular LNs should be treated as regional LNs at least in patients with upper and middle thoracic esophageal squamous cell carcinoma (ESCC).
Background: Neoadjuvant chemoradiotherapy (NACRT) followed by esophagectomy is now the standard treatment for patients with resectable advanced thoracic esophageal squamous cell carcinoma (ESCC) worldwide. However, the efficacy of NACRT followed by esophagectomy with three-field lymph node dissection for clinical Stage III patients and for clinical Stage IVB patients with supraclavicular LN metastasis has not yet been determined. Methods: Between 2008 and 2018, 94 ESCC patients diagnosed as clinical Stage III and 18 patients diagnosed as clinical Stage IVB with supraclavicular LN metastasis as the only distant metastatic factor were treated with NACRT followed by esophagectomy with extended lymph node dissection at Akita University Hospital. Long-term survival and the patterns of recurrence in these 112 patients were analyzed. Results: The median follow-up period of censored cases was 60 months. The five-year OS and DSS rates among the clinical Stage III patients were 57.6% and 66.6%, respectively. The five-year OS and DSS rates among the clinical Stage IVB patients were 41.3% and 51.6%, respectively. The most frequent recurrence pattern was distant metastasis (69.2%) in the Stage III patients and LN metastasis (75.0%) in the Stage IVB patients. Conclusion: NACRT followed by esophagectomy with three-field LN dissection is feasible and offers the potential for long-term survival of clinical Stage III ESCC patients and even clinical Stage IVB patients with supraclavicular LN metastasis as the only distant metastatic factor. At least in patients with upper and middle thoracic ESCC, treating supraclavicular LNs as regional LNs seems to be appropriate. View Full-Text
Keywords: esophageal cancer; esophageal squamous cell carcinoma; prognosis; neoadjuvant treatment; chemoradiotherapy; NACRT; three-field; supraclavicular LN metastasis esophageal cancer; esophageal squamous cell carcinoma; prognosis; neoadjuvant treatment; chemoradiotherapy; NACRT; three-field; supraclavicular LN metastasis
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MDPI and ACS Style

Sato, Y.; Motoyama, S.; Wada, Y.; Wakita, A.; Kawakita, Y.; Nagaki, Y.; Terata, K.; Imai, K.; Anbai, A.; Hashimoto, M.; Minamiya, Y. Neoadjuvant Chemoradiotherapy Followed by Esophagectomy with Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma Patients with Clinical Stage III and with Supraclavicular Lymph Node Metastasis. Cancers 2021, 13, 983. https://doi.org/10.3390/cancers13050983

AMA Style

Sato Y, Motoyama S, Wada Y, Wakita A, Kawakita Y, Nagaki Y, Terata K, Imai K, Anbai A, Hashimoto M, Minamiya Y. Neoadjuvant Chemoradiotherapy Followed by Esophagectomy with Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma Patients with Clinical Stage III and with Supraclavicular Lymph Node Metastasis. Cancers. 2021; 13(5):983. https://doi.org/10.3390/cancers13050983

Chicago/Turabian Style

Sato, Yusuke, Satoru Motoyama, Yuki Wada, Akiyuki Wakita, Yuta Kawakita, Yushi Nagaki, Kaori Terata, Kazuhiro Imai, Akira Anbai, Manabu Hashimoto, and Yoshihiro Minamiya. 2021. "Neoadjuvant Chemoradiotherapy Followed by Esophagectomy with Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma Patients with Clinical Stage III and with Supraclavicular Lymph Node Metastasis" Cancers 13, no. 5: 983. https://doi.org/10.3390/cancers13050983

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