Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival.
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.
Berger
Adam C
AC
Department of Surgical Oncology, and Division of Biostatistics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.
Farma
Jeffrey
J
Scott
Walter J
WJ
Freedman
Gary
G
Weiner
Louis
L
Cheng
Jonathan D
JD
Wang
Hao
H
Goldberg
Melvyn
M
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