Chemoradiation Therapy for Esophageal Cancer Did Not Decrease Survival During the Later Period Compared With Surgery Alone at More Than 10 Year Follow-up

Abstract

Chemoradiation therapy (CRT) is a curative treatment option for esophageal squamous cell carcinoma. However, critical late toxicities after definitive CRT may worsen the long-term results compared with surgery. To assess the late influences, the long-term outcomes of CRT and surgery were compared in patients with resectable esophageal cancer. Between 2001 and 2005, 99 patients with clinical stage T1-3N0-1M0 thoracic squamous cell carcinoma were entered on a single-institutional prospective comparative study, of which the patients themselves decided on either CRT (n=51) or surgery (n=48). The CRT course consisted of two cycles of cisplatin and fluorouracil with split-course concurrent radiation of 60 Gy in 30 fractions. Medically fit patients with persistent or recurrent disease after CRT underwent salvage strategies such as esophagectomy or endoscopic treatment. Patients were seen every three months for two years, every six months for the next three years, and at the end of each year after that. For 51 CRT patients and 48 surgery patients, median ages at diagnosis were 63 and 65.5 years; 84% and 92% were male; clinical stages were I, II, and III in 15, 17, and 19 and in 10, 17, and 23, respectively. There were no significant differences in known prognostic factors between two groups. The median follow-up duration was 10.8 years. The 5- and 10-year survival rates were 68.5% and 57.1%, respectively, in the CRT patients, compared with 49.4% and 37.3%, respectively, in the surgery patients (p = 0.038). Of the CRT patients, 13 (25%) underwent salvage esophagectomy almost within one year (median 8.2 months). 78.8% (23/30) and 76.9% (20/26) of recurrence occurred within the first three years in CRT patients and surgery patients, respectively. Late occurrence (> three years) of deaths due to primary cancer, secondary cancer, and intercurrent disease were 4, 2, and 3, respectively, in the CRT patients, and were 4, 1, and 1, respectively, in surgery patients (no significant difference). Definite chemoradiation therapy did not significantly increase late death from any cause compared with surgery alone. Chemoradiation therapy with selective surgery is a promising alternative to surgery for resectable esophageal squamous cell cancer.