Analysis of the role of adjuvant chemotherapy for invasive carcinoma of the esophagus

The purpose of this report is to analyze the role and optimum integration o f chemotherapy for invasive carcinoma of the esophagus in the combined moda lity setting. The charts of 157 patients with primary invasive nonmetastati c carcinoma of the esophagus treated with curative intent between 1984 and 1998 were reviewed. Various combinations of chemotherapy (C), radiotherapy (R), and surgery (S) were used. Chemotherapy was multiagent (typically 5-fl uorouracil [5-FU]/cisplatin/hydroxyurea, 5-FU/cisplatin/leucovorin, or doce taxel/cisplatin) for all but seven patients treated with single agents. The clinical endpoints examined were overall survival (OS) and cause-specific survival (CSS). Multivariate analyses and pairwise comparisons were made fo r determination of the benefit of chemotherapy. On the multivariate analyse s, only American Joint Committee on Cancer stage and chemotherapy were stat istically significant determinants of both OS and CSS. Following are the re sults of the pairwise analyses: 3-year OS: (no C) versus (any C): 16% Versu s 27% (p = 0.02); (S) versus (C;S): 19% versus 34% (p = 0.35); (R) versus ( C+R): 0% versus 13% (p = 0.05); (R + S) versus (C + R + S): 18% versus 33% (p = 0.03). The administration of adjuvant chemotherapy can improve surviva l in patients with invasive nonmetastatic esophageal carcinoma. This benefi t appears to be greater when chemotherapy is given with radiotherapy (with or without surgery) than in the absence of radiotherapy, perhaps because of a radiosensitizing effect not possible when using surgery is the only loca l control modality.