title: Neoadjuvant chemoradiotherapy followed by esophagectomy vs. surgery alone in the treatment of resectable esophageal squamous cell carcinoma.
abstract: In order to improve the survival of esophageal cancer patients, a trimodality therapy consisting of esophagectomy in combination with neoadjuvant chemoradiotherapy (CRT) has been developed. In this study, we evaluated whether neoadjuvant CRT improved the outcomes of patients with resectable esophageal squamous cell carcinoma (ESCC) compared to surgery alone. Eighty-eight patients with resectable ESCC were treated with either neoadjuvant CRT followed by surgical resection (Group A, n=52), or surgery alone (Group B, n=36). CRT consisted of 5-fluorouracil (5-FU, 500 mg/m2on days 1-5) and cisplatin (CDDP, 10-20 mg/kg body weight on days 1-5), repeated after 3 weeks. Survival analysis was performed using the log-rank test with the Kaplan-Meier method. The clinical response of the primary tumor and metastatic nodes was 80.8%. The postoperative complications profile was similar between the two groups, except for anastomotic leakage. The median survival time (MST) was not reached in Group A and was 27.4 months in Group B. The estimated 5-year overall survival (OS) rate was 50.3% in Group A and 39.9% in Group B (P=0.134). As regards stage II/III disease, Group A exhibited a better disease-free survival (DFS) compared to Group B (5-year DFS: 57.2% in Group A vs. 31.4% in Group B; P=0.025). Simultaneous locoregional and distant recurrences were more common in the surgery alone group (Group B, P=0.047). Neoadjuvant CRT with 5-FU and CDDP did not contribute to a better prognosis in patients with resectable ESCC. However, it may be beneficial for patients with stage II/III disease.
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Surgery, Kanzaki Hospital, Amagasaki, Hyogo 661-0967;
authors.forename: Reigetsu
authors.initials: R
authors.lastname: Yoshikawa
authors.affiliation: Departments of Radiology, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kamikonya
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kitani
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsujie
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Masao
authors.initials: M
authors.lastname: Yukawa
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Johji
authors.initials: J
authors.lastname: Hara
authors.affiliation: Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan.
authors.forename: Takehira
authors.initials: T
authors.lastname: Yamamura
authors.affiliation: Department of Digestive Surgery, Nara Hospital, Kinki University School of Medicine, Ikoma, Nara 630-0293;
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Inoue
keywords: esophageal cancer; survival; trimodality therapy