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Salvage Surgery After Proton Beam-Based Chemoradiotherapy for Esophageal Squamous Cell Carcinoma: A Case Series Study
Hirohito Kakinuma1,2, Michitaka Honda3,4, Soshi Hori3,4
1Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan. h.kakinuma.0922@gmail.com.
Background:
Although salvage surgery after photon-based chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) is high risk, the safety of salvage surgery after proton beam-based chemoradiotherapy (PBC) remains unclear. This study aimed to evaluate the short- and long-term outcomes of salvage surgery after PBC.
Methods:
This single-arm retrospective case series included patients who underwent curative-intent salvage surgery for residual or recurrent ESCC after PBC between June 2009 and February 2020. Salvage surgery included esophagectomy with lymph node dissection or resection of recurrent lymph nodes. The primary outcome was major morbidity (Clavien-Dindo grade ≥III).
Results:
The study enrolled 19 patients with a median age was 64 years. Of the 19 patients, 12 underwent esophagectomy, and 7 underwent lymph node resection. Major morbidity occurred for 9 patients (47.3%). No operative mortality occurred. The median overall survival was 16.2 months. The 1-, 3-, and 5-year overall survival rates were 68.0%, 43.1%, and 35.9%, respectively.
Conclusion:
Salvage surgery after PBC for ESCC remains a high-risk procedure, and its feasibility should be carefully assessed on a case-by-case basis.
