title: Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival.
abstract: OBJECTIVE
  Attempts to improve survival of patients with esophageal cancer have been made using induction chemoradiotherapy (CRT) followed by surgery. A large single-center experience was reviewed to determine which treatment-related variables could predict survival and recurrence.
  
  
  METHODS
  All patients undergoing esophagectomy between January 1994 and December 2002 were reviewed. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazards models, and survival curves were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  Of 171 patients with invasive cancer, 131 (77%) underwent preoperative CRT. The average age was 60 years, and most patients were male (85%). Operations performed included Ivor-Lewis (60%), transhiatal (8%), three-hole (23%), or left thoracoabdominal (8%) esophagectomy. Perioperative mortality rate was 5%. Median overall survival (OS) of the entire group was 33 months, and the 5-year OS rate was 26%. Induction CRT was associated with a 33% 5-year survival rate compared with 11% for surgery alone (P = .43). Patients downstaged to pathologic stage 0 or I had an improved OS and disease-free survival (DFS) compared with those patients who were not downstaged (P = .022). Additionally, the ability to perform an R0 resection was a significant factor for OS and DFS (n = 130; P < .0001 and P <.0002, respectively).
  
  
  CONCLUSIONS
  Response to CRT and the ability to perform an R0 resection are associated with significantly improved survival in patients with esophageal carcinoma.
authors.affiliation: Department of Surgical Oncology, and Division of Biostatistics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Farma
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Scott
authors.forename: Gary
authors.initials: G
authors.lastname: Freedman
authors.forename: Louis
authors.initials: L
authors.lastname: Weiner
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Cheng
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Melvyn
authors.initials: M
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate