title: Impact of radiotherapy, chemotherapy and surgery in multimodal treatment of locally advanced esophageal cancer.
abstract: OBJECTIVE
  It was the aim of this study to assess our institutional experience with definitive chemoradiation (CRT) versus induction chemotherapy followed by CRT with or without surgery (C-CRT/S) in esophageal cancer.
  
  
  METHODS
  We retrospectively analyzed 129 institutional patients with locally advanced esophageal cancer who had been treated by either CRT in analogy to the RTOG 8501 trial (n = 78) or C-CRT/S (n = 51).
  
  
  RESULTS
  The median, 2- and 5-year overall survival (OS) of the entire collective was 17.6 months, 42 and 24%, respectively, without a significant difference between the CRT and C-CRT/S groups. In C-CRT/S patients, surgery statistically improved the locoregional control (LRC) rates (2-year LRC 73.6 vs. 21.2%; p = 0.003); however, this was translated only into a trend towards improved OS (p = 0.084). The impact of escalated radiation doses (≥60.0 vs. <60.0 Gy) on LRC was detectable only in T1-3 N0-1 M0 patients of the CRT group (2-year LRC 77.8 vs. 42.3%; p = 0.036).
  
  
  CONCLUSIONS
  Definitive CRT and a trimodality approach including surgery (C-CRT/S) had a comparable outcome in this unselected patient collective. Surgery and higher radiation doses improve LRC rates in subgroups of patients, respectively, but without effect on OS.
authors.affiliation: Department of Radiation Oncology, University of Tuebingen, Tuebingen, Germany. bernhard.berger@med.uni-tuebingen.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Berger
authors.forename: Katharina
authors.initials: K
authors.lastname: Stahlberg
authors.forename: Annina
authors.initials: A
authors.lastname: Lemminger
authors.forename: Martin
authors.initials: M
authors.lastname: Bleif
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.forename: Michael
authors.initials: M
authors.lastname: Bamberg
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011829:Radiation Dosage; D011836:Radiation Tolerance; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil