In Reply to Dr. Puri et al.

Abstract

To the Editor: I appreciate the opportunity to respond to the thoughtful letter from Dr. Puri et al. There is a certain population of patients who are not good candidates for surgery because of their poor cardiopulmonary function or who are hesitant about undergoing surgery. Although definitive chemoradiotherapy is not a standard treatment, it is curative and a good alternative treatment to surgery ( 1 Herskovic A. Martz K. al-Sarraf M. et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992; 326: 1593-1598 Crossref PubMed Scopus (1807) Google Scholar , 2 Smith T.J. Ryan L.M. Douglass Jr., H.O. et al. Combined chemoradiotherapy vs. radiotherapy alone for early Stage squamous cell carcinoma of the esophagus: A study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 1998; 42: 269-276 Abstract Full Text Full Text PDF PubMed Scopus (249) Google Scholar , 3 Chan A. Wong A. Is combined chemotherapy and radiation therapy equally effective as surgical resection in localized esophageal carcinoma?. Int J Radiat Oncol Biol Phys. 1999; 45: 265-270 Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar , 4 Hironaka S. Ohtsu A. Boku N. et al. Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2-3)N(any) M(0) squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys. 2003; 57: 425-433 Abstract Full Text Full Text PDF PubMed Scopus (188) Google Scholar ). Therefore we have applied definitive chemoradiotherapy to patients at poor risk for surgery or who had chosen nonsurgical treatment ( 5 Ishihara R. Yamamoto S. Hiroyasu I. et al. Factors predictive of tumor recurrence and survival after initial complete response of esophageal squamous cell carcinoma to definitive chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2010; 76: 123-129 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ). A limitation of this treatment is the high rate of recurrence, which has a major effect on survival after treatment ( 6 Ishikura S. Nihei K. Ohtsu A. et al. Long-term toxicity after definitive chemoradiotherapy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol. 2003; 21: 2697-2702 Crossref PubMed Scopus (330) Google Scholar , 7 Tahara M. Ohtsu A. Hironaka S. et al. Clinical impact of criteria for complete response (CR) of primary site to treatment of esophageal cancer. Jpn J Clin Oncol. 2005; 35: 316-323 Crossref PubMed Scopus (91) Google Scholar , 8 Minsky B.D. Pajak T.F. Ginsberg R.J. et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: High-dose versus standard-dose radiation therapy. J Clin Oncol. 2002; 20: 1167-1174 Crossref PubMed Scopus (1263) Google Scholar ). To improve the outcome of definitive chemoradiotherapy, early detection of recurrence is indispensable. For early detection of recurrence, this retrospective analysis to identify risk factors of recurrence was performed. Nonstandard Protocol for Treatment of Carcinoma Esophagus Does Not Suffice for Identification of Prognostic Markers in Retrospective StudyInternational Journal of Radiation Oncology, Biology, PhysicsVol. 77Issue 4PreviewTo the Editor: We read with interest the article by Ishihara et al. (1). There are several methodologic flaws in the write-up that raise some queries and perhaps do not justify the inclusion of the article in the journal. Full-Text PDF