Surgery Versus Definitive Chemoradiotherapy for Regionally Advanced Esophageal Squamous Cell Cancer

Abstract

Although historically surgical resection has been the chosen therapy for patients with advanced squamous cell carcinoma (SCC) of the esophagus, survival rates after surgery alone are poor. With advances in other modalities, including chemotherapy and chemoradiotherapy (CRT), the benefits of surgery for patients with advanced SCC of the thoracic esophagus have come into question. In particular, at issue is whether definitive CRT or CRT followed by surgery for patients with SCC of the thoracic esophagus provides the best course of treatment. In patients who do not show a complete clinical response to CRT, surgery may provide a benefit. However, whether surgical resection benefits patients who have a complete clinical response to CRT isn’t as clear. In these patients, surgery after CRT in locally advanced esophageal SCC may lessen local regional recurrence of tumors, but surgery provides little or no difference in survival and may lead to greater treatment-related mortality. Thus, the data are inconclusive with respect to whether CRT alone or followed by esophageal resection should be recommended to patients with regionally advanced SCC of the esophagus.