Localized squamous-cell cancer of the esophagus: retrospective analysis ofthree treatment schedules

Background and purpose: A retrospective study comparing chemotherapy and ra diation, esophagectomy alone versus preoperative radiochemotherapy and surg ery in localized squamous-cell esophageal carcinoma. Materials and methods: Between 1989 and 1995, 139 patients (40 stage I, 77 stage IIA and 22 stage IIB according to the UICC 78 TNM classification) wer e treated in two different institutions. They were divided into three group s according to the treatment proposed: E group (treatment by esophagectomy; n = 30), RCT + E group (treatment by preoperative radiochemotherapy and es ophagectomy; n = 46), RCT group (treatment by radiochemotherapy; n = 63). F actors like age, tumor localization and stage were similar in all groups. A n intention to treat analysis was made. Results: The E group showed no postoperative mortality, while in the RCT E group, the surgery mortality was 12.8%. The mortality after RCT was 1.7%. After preoperative radiochemotherapy, a pathological complete response was observed in 25% of cases and the curative resection rate was higher (82% a fter RCT + E versus 60% after E). The 5-year survival difference between th e three groups was not relevant (E group, 12.6%; RCT group, 25.8%; RCT + E group, 38.7%). The median survival was 29, 24 and 28.5 months, respectively . The event-free survival was identical for the E group and the RCT group. For patients treated by radiochemotherapy, local and/or distant relapses we re significantly reduced by esophagectomy (relapses occurred in 51% of pati ents in the RCT + E group versus 75% in the RCT group, P = 0.017). Palliati ve care (dilatations, prosthesis, gastrostomy or jejunostomy) to improve dy sphagia was necessary for 38% of patients treated by exclusive radiochemoth erapy versus 11% of patients treated by surgery (P = 0.001). Conclusions: Treatments by esophagectomy or radiochemotherapy were not sign ificantly different. Preoperative radiochemotherapy and surgery lead to a h igher survival rate than exclusive radiochemotherapy, however, with a high postoperative mortality rate. This study suggests the relevance of a prospe ctive randomized trial to compare RCT + E and RCT alone. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.