title: Outcomes of patients with squamous cell carcinoma of esophagus who did not receive surgical resection after neoadjuvant radiochemotherapy.
abstract: OBJECTIVE
  The primary objective was to assess the different reasons for refusal of surgical resection (SR) in patients with esophageal squamous cell cancer (ESCC), who were initially planned for neoadjuvant radiochemotherapy (N-RCT) + SR, but SR was not performed after N-RCT.
  
  
  METHODS
  From 1988 to 2011, 311 patients with ESCC were treated with N-RCT in a tertiary referral center for esophageal diseases. Fifty-three patients were analyzed who received RCT with 40-45 Gy and concomitant chemotherapy in neoadjuvant intention, but in whom the treatment was stopped or switched to definitive RCT due to progression, patient decision, or new findings.
  
  
  RESULTS
  The reasons for refusal of SR for these 53 patients were as follows: (1) patients' or physicians' preference for the planned treatment was changed during the N-RCT, such that RCT was continued to a curative dose without a break (group 1, n = 23, 44%); (2) patients were restaged after 4 weeks, and the tumor board decided to continue RCT because R0 resection was unlikely and/or patients were medically unfit (group 2, n = 15, 28%); (3) patients refused continuation of any treatment (group 3, n = 15, 28%). Refusal of SR was significantly more likely in patients with longitudinal tumor dimension &gt;8 cm and those with an Eastern Cooperative Oncology Group performance status score of 2. Median follow-up time from the start of N-RCT was 57 months (range 1-137 months). The survival rates at 2 and 5 years were 36 ± 7% and 27 ± 7%, respectively. Group 1 had significantly longer survival.
  
  
  CONCLUSIONS
  The planned N-RCT+SR could not be completed in a considerable number of patients in a tertiary referral center. More strict selection criteria for multimodality treatment including SR could spare some of these patients an incomplete treatment and probably lead to increased utilization of definitive RCT.
authors.affiliation: 2 Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich - Germany.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Fakhrian
authors.forename: Arif Deniz
authors.initials: AD
authors.lastname: Ordu
authors.forename: Carsten
authors.initials: C
authors.lastname: Nieder
authors.forename: Florian
authors.initials: F
authors.lastname: Lordick
authors.forename: Philipp Günther
authors.initials: PG
authors.lastname: Kup
authors.forename: Jörg
authors.initials: J
authors.lastname: Theisen
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
authors.forename: Hans
authors.initials: H
authors.lastname: Geinitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D000075202:Contraindications; D003657:Decision Making; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D016896:Treatment Outcome; D016312:Treatment Refusal; D015431:Weight Loss
chemical_list: D002945:Cisplatin; D005472:Fluorouracil