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Ann Thorac Surg 2004;77:1193-1199
© 2004 The Society of Thoracic Surgeons

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Original article: general thoracic

Preoperative chemoradiation therapy does not improve early survival after esophagectomy for patients with clinical stage III adenocarcinoma of the esophagus

^a Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Accepted for publication September 4, 2003.

^* Address reprint requests to Dr Miller, Section of General Thoracic Surgery, Emory University Clinic, 1365 Clifton Rd NE, Atlanta, GA 30322, USA
e-mail: daniel_miller{at}emoryhealthcare.org

Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami Beach, FL, Nov 7–9, 2002.

BACKGROUND: The optimal treatment for locally advanced esophageal cancer remains controversial. The objective of this study was to determine if preoperative chemoradiation therapy (P-CRT) followed by esophagectomy for patients with clinical stage III adenocarcinoma of the esophagus offered any survival advantage as compared with esophagectomy alone.

METHODS: Between January 1998 and June 2001, 75 nonrandomized patients with clinical stage III adenocarcinoma of the esophagus underwent either P-CRT and esophagectomy or esophagectomy alone. All patients were staged before initiation of treatment with computed tomography and endoscopic ultrasound.

RESULTS: P-CRT followed by esophagectomy was performed in 47 patients (63%) and esophagectomy alone in 28 patients (37%). Although the P-CRT group was younger (median age, 61 years versus 67 years), the two groups were otherwise similar for gender, comorbidities, and symptoms. Overall operative mortality was 4%. Follow-up was complete in all patients and ranged from 5 to 40 months (median, 20 months). Overall, one-, two-, and three-year survivals were 72%, 44%, and 42%, respectively. Three-year survival was identical (42%) for both the P-CRT and surgery alone patients (p = 0.70). Three-year disease-free survival for the P-CRT group was 29% as compared with 33% for the surgery only group (p = 0.51).

CONCLUSIONS: Patients with clinical stage III adenocarcinoma of the esophagus do not appear to gain an early overall or disease-free survival advantage when treated with P-CRT followed by surgery as compared with surgery alone. However, long-term follow-up is needed. A large, prospective, randomized trial is warranted to address the question of whether P-CRT offers any survival benefit or impact on pattern of recurrence in patients undergoing esophagectomy for locally advanced disease.

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				T. D. Luu, P. Gaur, S. D. Force, C. A. Staley, K. A. Mansour, J. I. Miller Jr, and D. L. Miller Neoadjuvant Chemoradiation Versus Chemotherapy for Patients Undergoing Esophagectomy for Esophageal Cancer Ann. Thorac. Surg., April 1, 2008; 85(4): 1217 - 1224. [Abstract] [Full Text] [PDF]