Cervical nodal metastasis from intrathoracic esophageal squamous cell carcinoma is not necessarily an incurable disease

Abstract

Background: It remains controversial whether metastatic cervical lymph nodes in patients with intrathoracic esophageal cancer signify distant metastases, and therefore incurable; or they should be regarded as regional spread with still a potential for cure. The aim of this study is to review the treatment results in this group of patients. Patients and Methods: Patients with intrathoracic esophageal squamous cell carcinoma from 1995-2007 were included. Only those who had cervical lymph node spread confirmed by fine needle aspiration cytology were studied. Patients with cancers in the cervical esophagus or gastric cardia, or histology other than that of squamous cell were excluded. Results: There were 115 patients who satisfied the inclusion criteria, of whom 98 (89.9%) were men. The median age was 62 years (range: 34-88). Treatment methods included: chemoradiation plus salvage surgery [n=22 (20.2%)]; chemoradiation [n=51 (46.8%)]; primary surgical resection [n=4 (3.7%)]; chemotherapy [n=2 (1.8%)]; radiotherapy [n=7 (6.4%)]; chemoradiation with bypass surgery [n=2 (1.8%)]; prosthetic intubation [n=12 (11%)]; and no intervention [n=9(8.2%)]. The median survival of patients with chemoradiation plus salvage surgery was significantly longer than those with surgery alone [34.8months vs 5.9months; p=0.029] or patients with chemoradiation [34.8 months vs 8.9 months; p=0.0003]. There was no hospital mortality in patients who had chemoradiation plus salvage surgery. Twelve out of the 22 patients who had chemoradiation and resection were downstaged from stage IV to stage 0-II. Conclusions: Despite staged as stage IV disease; prognosis of patients with metastatic cervical nodes was not uniformly poor. Up to 20% could derive good survival after chemoradiation and surgical resection.