title: Chemoradiotherapy with and without esophagectomy for advanced esophageal cancer.
abstract: OBJECTIVE
  To evaluate the impact of surgery on survival after chemoradiotherapy, we analyzed the long-term outcome of patients with advanced esophageal cancer.
  
  
  METHODS
  Data on 92 consecutive patients with T3 or T4 esophageal cancer who were initially treated by chemoradiotherapy were reviewed retrospectively. Of 82 patients who completed the planned schedule, 35 patients underwent esophagectomy (CRT+E Group) and 47 patients received definitive chemoradiotherapy (CRT Group).
  
  
  RESULTS
  A response to chemoradiotherapy was obtained in 71% of all 92 patients. The 1- and 3-year survival rates in the patients with T3M0 were 87 and 44 percent respectively, while these in the patients with T4 and/or M1(Lymph) disease were 47 and 20 percent. Although there was no difference in overall survival between the CRT+E Group and the CRT Group, the survival of responders in the CRT+E Group was significantly higher than that of those in the CRT Group (P=0.0448). The locoregional recurrence rate of responders in the CRT Group was higher than that in the CRT+E Group. Multivariate analysis showed that the independent prognostic factors were response, M(Lymph), and esophagectomy.
  
  
  CONCLUSIONS
  Although this study was retrospective and nonrandomized, esophagectomy after chemoradiotherapy might improve the survival of responders for locoregional control.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Japan. tsutomu@ige.twmu.ac.jp
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Masaho
authors.initials: M
authors.lastname: Ota
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hayashi
authors.forename: Reiki
authors.initials: R
authors.lastname: Eguchi
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ide
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
authors.forename: Norio
authors.initials: N
authors.lastname: Mitsuhashi
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012189:Retrospective Studies