Multimodality treatment for esophageal cancer - Surgery, is it necessary?

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Purpose : To compare the outcomes after esophagectomy versus those after chemoradiotherapy for potentially respectable (T2-3,NO-1,MO) esophageal cancerMaterials:1) squamous cell carcinoma in the thoracic esophagus2) potentially respectable cancer, cT2-3, cNO-1, cMO, cStage II-III3) patients at a low risk for both esophagectomy and definitive chemoradiotherapy4) no double primary cancers5) obtaining informed consentMethods : Patients choose one arm among the following three treatment arms after informed consent.1) esophagectomy (S)2) definitive chemoradiotherapy (CRT)3) neoadjuvant chemoradiotherapy (NA) ; Patients choose surgery or non-surgical treatment after being informing of the response to the neoadjuvant chemoradiotherapyResults : A hundred and two patients participated in this trial, from 2003 to 2006. There were 76 patients in the esophagectomy (S) group, 18 in the definitive chemoradiotherapy (CRT) group, and 8 in the neoadjuvant chemoradiotherapy (NA) group.1) S Group : There … More were 59 patients who underwent Ro resection, 16 who underwent R1R2 resection, and one who underwent only exploratory thoracotomy. The 1-, 2-, and 3-year-survival rate was 81%, 56%, and 49%, respectively in the S Group.2) CRT Group : There were 14 patients with complete response, and 4 with incomplete response. There was no patient who underwent salvage surgery. The 1-, 2-, and 3-year-survival rate was 89%, 68%, and 46%, respectively in the CRT Group.3) NA Group : There were three patients who underwent esophagectomy, and five who did not. The 1-, and 2-year-survival rate was 50% and 50%, respectively in the NA Group.The 1-, 2-, and 3-year-survival rate was 81%, 56%, and 49%, respectively in those patients who chose the surgical treatment at first, and was 74%, 60%, and 40%, respectively in those patients who chose the non-surgical treatment at first (the CRT Group + the NA Group)Conclusions : The outcomes after chemoradiotherapy for potentially respectable (T2-3,NO-1,MO) esophageal cancer may be similar to those after surgery. Less