SQUAMOUS-CELL CARCINOMA OF THE ESOPHAGUS

The role of surgery as primary treatment for patients with squamous ce ll carcinoma of the esophagus (SCCE) has been challenged by an improve d response rate for radiotherapy that is made possible by adding radio sensitizing chemotherapy. The purpose of our study was to review our i nstitution's treatment results for SCCE and to compare results of radi ation versus surgery as primary treatment of early stage disease. A re trospective chart review was done on 241 patients who were treated wit h SCCE at Kansas University Medical Center and affiliated hospitals be tween 1970 and 1990. Patients were divided into five groups based on t reatment received: (A) No Treatment; (B) Surgery Only; (C) Surgery plu s Adjuvant Chemoradiotherapy; (D) Radiation Therapy Only; and (E) Chem oradiotherapy. Surgical treatment groups B and C had the best overall survival of all groups. To reduce any bias due to stage differences in groups, survival of groups was assessed only for early stage disease patients (Stage I, IIa, IIb). For Stage I and II patients receiving su rgery as primary treatment (groups B and C), 29 per cent had a surviva l at 5 years compared to patients receiving primary radiation treatmen t (groups D and E) who had a combined survival of only four per cent. Although attempting comparison of risk groups is always a problem in n onrandomized studies, it is significant that only one 5-year survivor was in the nonresection radiation treatment groups D and E. Surgical r esection for SCCE had the best survival in our study, especially in pa tients with early stage disease.