NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER - IS IT WORTHWHILE

Background: With promising results from several institutions, many cen ters began treating patients with esophageal. cancer with neoadjuvant chemoradiotherapy (NC) followed by esophagectomy. This approach is dem anding for the patient and has not been proved to be better than esoph agectomy alone. Objective: To assess survival time and measures of qua lity of life associated with NC. Design: A retrospective review during 1990 to 1996. Setting: The 3 tertiary academic hospitals affiliated w ith the University of Massachusetts Medical School, Worcester. Partici pants: All patients (N = 51) with cancer of the middle or lower esopha gus who were treated with NC followed by esophagectomy during this per iod. Main Outcome Measures: Median and 1-, 2-, and 3-year survival tim es; median preoperative treatment time (first office visit for surgica l consultation before beginning NC to the date of surgery), median hos pital stay, and postoperative swallowing function. Results: The median survival time of all patients was 16.3 months; 1-, 2-, and 3-year ove rall survival rates were 67%, 46%, and 39%, respectively. The median h ospital stay was 12 days. The median postoperative treatment time was 3.3 months, which was 20% of the median survival time. Of the 51 patie nts, 19 were alive with a median follow-up time of 2.5 years. Twenty-n ine percent of the patients had a complete pathological response with median and 1-, 2-, and 3-year survival rates of 17.5 months, 73%, 57%, and 57%, respectively. Palliation of dysphagia was excellent, with 44 (93%) of 47 operative survivors taking either a soft diet (18 [38%]) or a regular (26 [55%]) diet by the first postoperative visit. Conclus ions: Median survival time with NC followed by esophagectomy for resec table cancer of the esophagus does not appear to be significantly bett er than that reported for esophagectomy alone. Further, treatment time with NC consumed 20% of survival time. Examining only these outcome v ariables suggests that NC is not worthwhile. However, examining a long er-term outcome survival variable, such as 3-year survival time, sugge sts that NC followed by esophagectomy may result in greater longterm s urvival than that reported for esophagectomy alone. We conclude that f urther randomized, controlled studies are necessary before NC followed by esophagectomy is considered superior to esophagectomy alone for th e treatment of resectable esophageal cancer.