Abstract
Purpose: To assess overall survival (OS) of esophageal cancer patients treated either by esophagectomy or chemoradiation (CRT). Methods: The medical records of patients with non metastatic esophageal cancer, treated with esophagectomy and those treated with concurrent CRT were analyzed. For all patients, files were reviewed for age, sex, tumor site and type, grade, disease stage and survival. The Log- rank test was used to examine differences in OS rates. Results: The medical records of 90 patients were analyzed. After a median follow up of 20 months, 2-year OS rate for the whole group was 46%. There was significant differences in 2-year OS in favor of patients treated by concurrent CRT (55.4%) compared to those treated by surgery (31%) (p=0.016, HR:1.96, 95% CI: 1.13–3.38). Univariate analysis showed that patients in each treatment group, had comparable 2-year OS rates regarding patient’s age, gender, pathologic subtype, and histologic grade (p>0.05). Disease stage in each group and tumor site in CRT group significantly affected OS rates (p<0.05). Conclusions: Survival rates were statistically significant higher in patients treated with CRT than in those underwent esophagectomy. Prognostic factors that affected survival were disease stage in each treatment group and tumor site in CRT group.
Highlights
Esophageal cancer is associated with a poor prognosis, with a 5-year survival rate of 16% (Ries et al, 2008)
There was significant differences in 2-year overall survival (OS) in favor of patients treated by concurrent CRT (55.4%) compared to those treated by surgery (31%) (p=0.016, HR:1.96, 95% CI: 1.13–3.38)
Survival rates were statistically significant higher in patients treated with CRT than in those underwent esophagectomy
Summary
Esophageal cancer is associated with a poor prognosis, with a 5-year survival rate of 16% (Ries et al, 2008). Surgery was the main treatment option of esophageal carcinoma but resulted in dismal survival (Siewert et al, 2001). The addition of post-operative radiation therapy results in radiation sequels as gastritis in the pulled up gastric remnant (Fok et al, 1993), and anastomotic strictures in the irradiated patients (Zieren et al, 1995). The discouraging results of surgery and the need for more effective therapy led to the development of definitive chemo-radiation (CRT) for esophageal cancer (Neuner et al, 2009). Meta-analyses have confirmed that neoadjuvant CRT resulted in a significant survival benefit in patients with esophageal carcinoma (Gebski et al, 2007; Kranzfelder et al, 2011; Sjoquist et al, 2011). The radiosensitizing effect of chemotherapy and control of micro-metastatic disease justify addition of chemotherapy to radiation therapy (Shridhar et al, 2013) which can be given either concurrently or sequentially
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