Comparison of transthoracic esophagectomy with definitive chemoradiotherapy as initial treatment for esophageal squamous cell carcinoma in patients who could tolerate transthoracic esophagectomy.

Abstract

145 Background: Transthoracic esophagectomy (TTE) and definitive chemoradiotherapy (dCRT) have been recognized as initial curative treatments for esophageal squamous cell carcinoma (ESCC). We aimed to compare TTE with dCRT as initial treatments in patients who had potentially curable ESCC and could tolerate TTE. Methods: Consecutive patients who were histologically diagnosed as ESCC with stage I/II/III (excluding cT4 or cN3) or stage IV due to supraclavicular lymph node metastasis and were planned to undergo surgery or chemoradiotherapy as an initial treatment were eligible for this retrospective study. In order to select patients who could tolerate TTE, respiratory function, ECOG PS and preoperative complications were additionally considered in patients’ selection. Patient characteristics, recurrence free survival (RFS), 3-year and 5-year overall survival (3yOS, 5yOS) and the treatments after failure of initial treatments were investigated. Results: 112 patients were included in TTE, 65 in dCRT. No significant differences were observed in age, sex and clinical stage between TTE and dCRT (stage I/II/III/IIV of 29/47/46/10 in TTE, 23/15/20/7 in dCRT). R0 resection rate was 87% in TTE and CR rate was 68% in dCRT. In intension to treat analysis, there was no significant difference in RFS of non-stage IA patients. In contrast, 3yOS was significantly longer in TTE than dCRT (TTE, 66.3%; dCRT, 51.0%; P=0.029).In non-stage IA patients, after initial treatment failure, significantly more patients could undergo local treatment (radiotherapy or surgery in TTE, surgery or endoscopic resection or photodynamic therapy in dCRT) in TTE than dCRT (TTE 74%, dCRT 40%, P=0.003). Conclusions: In patients with locally advanced ESCC who could tolerate TTE, TTE could extend short term survival, which might be encouraged by utilizing local treatment after initial treatment failure.