title: [Esophageal cancer: outcome according to therapeutic strategy].
abstract: OBJECTIVE
  To assess the outcome of esophageal cancer according to therapeutic strategy.
  
  
  METHODS
  One-hundred and twenty patients with esophageal cancer treated by an association of radiotherapy and chemotherapy and possibly surgery, between 2004 and 2010, were retrospectively studied. The first site of relapse was classified as follows: local (tumour), locoregional (tumour and/or nodal: celiac, mediastinal, sus-clavicular) or metastatic.
  
  
  RESULTS
  With a 15.7-months (1.4-62) median follow-up, there were 89 deaths and 79 recurrences. Three types of treatments were performed: 50Gy exclusive chemoradiotherapy (47 patients) or 50 to 65Gy exclusive chemoradiotherapy (44 patients) or chemoradiotherapy followed by surgery (27 patients). The local first relapse was as much frequent as distant relapse (50 patients). With a-5cm margin up and down to the tumour, there was only one nodal relapse. Two-year survival was 39.5% (95% confidence interval [IC]: 30.5-40.8) and relapse-free survival was 26.5% (CI: 18.6-35). Multivariate analysis revealed that treatment type and disease stage had a significant impact on survival, relapse-free survival and locoregional control. Compared to exclusive chemoradiotherapy, surgery improved locoregional control (40.2 versus 8.7 months, P=0.0004) but in a younger population. Despite postoperative mortality, the gain was maintained for distance relapse-free survival (40.2 versus 10 months, P=0.0147) and overall survival (29.3 versus 14.2 months, P=0.0088). Compared to 50Gy chemoradiotherapy, local control was improved if high dose chemoradiotherapy was performed (13.8 versus 7.5 months, P=0.05) but not overall survival (14.0 versus 15.4 months, P=0.24).
  
  
  CONCLUSIONS
  More than one-third relapse is local. Locoregional control is better with high dose chemoradiotherapy. In this study, surgery performed in selected patients only, improved locoregional control, relapse-free disease and overall survival.
authors.affiliation: Département d'oncologie radiothérapie, institut de cancérologie de l'Ouest Paul-Papin, 2, rue Moll, 49000 Angers, France. rousseaudominique@hotmail.fr
authors.forename: D
authors.initials: D
authors.lastname: Rousseau
authors.forename: O
authors.initials: O
authors.lastname: Capitain
authors.forename: F
authors.initials: F
authors.lastname: Denis
authors.forename: S
authors.initials: S
authors.lastname: Girault
authors.forename: A-L
authors.initials: AL
authors.lastname: Poirier
authors.forename: A
authors.initials: A
authors.lastname: Paumier
authors.forename: P
authors.initials: P
authors.lastname: Cellier
authors.forename: A
authors.initials: A
authors.lastname: Hamy
authors.forename: M-A
authors.initials: MA
authors.lastname: Mahé
authors.forename: N
authors.initials: N
authors.lastname: Mesgouez-Nebout
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016629:Esophagectomy / Q000706:statistics & numerical data; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards; D016896:Treatment Outcome
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D016190:Carboplatin; D002945:Cisplatin; D005472:Fluorouracil