IS ESOPHAGECTOMY FOLLOWING UPFRONT CHEMORADIOTHERAPY SAFE AND NECESSARY

Objective: To examine the safety and necessity of esophagectomy follow ing upfront chemoradiotherapy (CRT) in patients with potentially resec table esophageal cancer. Design: Cohort analytic study during a 4-year period. Setting: Tertiary referral center. Patients: Thirty-seven pat ients who completed CRT and underwent esophagectomy as compared with 3 0 patients who underwent esophagectomy alone without pretreatment duri ng the same period. Main Outcome Measures: Resection-related events, p erioperative morbidity and mortality, response to CRT, site of residua l disease following CRT, and survival of partial responders. Results: Patients receiving CRT followed by esophagectomy were similar to patie nts who underwent esophagectomy alone for operative characteristics, p ostoperative course, and perioperative morbidity and mortality. Of the 33 patients who achieved an objective response to CRT, 23 had residua l tumor in the resection specimen. Of the 18 patients alive with no ev idence of disease at a median follow-up of 30 months, 50% had residual tumor following CRT. Conclusions: Upfront CRT did not adversely affec t resection-related outcome and may facilitate resection by downstagin g disease. A considerable number of patients had prolonged survival af ter esophageal resection despite having residual tumor present followi ng treatment with upfront CRT. Therefore, esophagectomy following upfr ont CRT can improve locoregional control of disease and should remain a critical component of any multimodality regimen.