title: Long-term Treatment Outcomes for Locally Advanced Esophageal Cancer: A Single-Institution Experience.
abstract: To determine long-term outcomes in patients with locally advanced esophageal carcinoma treated with trimodality therapy (chemoradiotherapy [CRT] and surgery, TMT) or definitive CRT.
  
  
  
  We retrospectively identified patients with advanced esophageal carcinoma treated with curative intent at our institution between 1998 and 2004. Identified patients were separated into 3 groups: patients who received TMT, patients who received CRT, and patients who began treatment with trimodality intent but did not undergo surgery (PTMT). Local control, overall survival (OS), and distant metastasis-free survival were compared using Kaplan-Meier statistics.
  
  
  
  Among the 265 patients included, median follow-up was 6.4 years for surviving patients and 1.7 years for all patients. Type of esophageal cancer was adenocarcinoma in 213 patients (80%) and squamous cell carcinoma in 46 patients (17%). Treatment groups comprised 169 patients (64%) completing TMT, 46 patients medically unable to undergo surgery after neoadjuvant therapy (PTMT), and 50 (19%) who underwent CRT. Median OS was 20.5 months; actuarial 5- and 10-year OS were 27% and 12%, respectively. The TMT group had the highest 5- and 10-year OS (32% and 19%, respectively). Local control rates at 2, 5, and 10 years for all patients were 80%, 70%, and 69%, respectively. By treatment modality, 5-year local control was best (82%) for TMT, compared with 60% for CRT and 40% for PTMT groups (P<0.001).
  
  
  
  Patients who completed TMT had the best local control and long-term OS. In the context of TMT, surgery seemed more beneficial in patients with esophageal adenocarcinoma versus squamous cell carcinoma.
authors.affiliation: *Department of Radiation Oncology ‡Division of Medical Oncology, Mayo Clinic, Rochester, MN †West Hills Radiation Therapy Center, West Hills, CA §Radiation Oncology Department, Therapeutic Radiologists Inc., Kansas City, MO.
authors.forename: Terence T
authors.initials: TT
authors.lastname: Sio
authors.forename: Zachary C
authors.initials: ZC
authors.lastname: Wilson
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stauder
authors.forename: Sumita
authors.initials: S
authors.lastname: Bhatia
authors.forename: James A
authors.initials: JA
authors.lastname: Martenson
authors.forename: J Fernando
authors.initials: JF
authors.lastname: Quevedo
authors.forename: David A
authors.initials: DA
authors.lastname: Schomas
authors.forename: Robert C
authors.initials: RC
authors.lastname: Miller
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil