Study on multimodal treatment for a locally-advanced esophageal cancer. Surgery, is it necessary?

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1. Purpose : To evaluate the necessity of esophageal surgery after chemoradiotherapy for a locally- advanced (T4) esophageal cancer2. Methods : a prospective non-randomized trial based on informed consent comparing chemoradiotherapy followed by surgery (CRTx+S) versus chemoradiotherapy alone (CRTx-alone).3. Patients' criteria : (1) T4 squamous cell carcinoma in the thoracic esophagus, (2) without distant metastasis (M0), (3) less than 75 year-old, (4) Performance status=0〜2, (5) without active other primary cancer(s), (6) informed consent.4. Results : Fifty-three patients were enrolled from 1994 to 2002, 29 in the CRTx+S group and 24 in the CRTx-alone group. The responders (CR/PR) to the 1^<st> course of chemoradiotherapy - induction chemoradiotherapy - were 31 (58%), and the non-responders (NC/PD) were 22 (42%). The survival rates of patients with a T4 esophageal cancer were not correlated to surgery, but to the effect of chemoradiotherapy. In responders to chemoradiotherapy, there was no difference in the survival rates between the CRTx+S group and the CRTx-alone group, while in non-responders, the survival rates were better in the CRTx+S group than in the CRTx- alone group.5. Conclusions : Surgery is not necessary for the responders to chemoradiotherapy, while it is necessary for the non-responders.