Long-term survival following induction chemoradiotherapy and esophagectomyfor esophageal carcinoma

Hypothesis: Long-term survival is rare in patients treated for esophageal c arcinoma. Several clinical trials suggest the possibility of prolonged surv ival in patients who undergo induction chemoradiotherapy plus esophagectomy . Design: Prospective uncontrolled study. Setting: University hospital. Patients and Methods: Forty-four patients with carcinoma of the esophagus o r gastroesophageal junction were prospectively entered into a phase II tria l of preoperative 5-fluorouracil, cisplatin, and interferon alfa with concu rrent external beam radiotherapy before esophagectomy. Curative resection w as performed on 36 of 41 patients who completed the induction chemoradiothe rapy. Results: Of the 44 patients, 17 are alive at a median follow-up of 50 month s. Of these 17 patients, 15 show no evidence of recurrent disease. Of the 1 4 patients with longterm survival (greater than or equal to3 years), 1 pati ent died of disease, and another patient is alive with disease. The remaini ng 12 patients are alive and disease-free (median follow-up, 54 months). Si x patients have survived longer than 4 years and 3 patients longer than 5 y ears. Subsequent primary tumors have developed in 2 patients. One patient h ad a recurrence at 11 months following initiation of treatment and remains disease-free 43 months postresection of a single brain metastasis. Standard clinicopathologic parameters (age, sex, histologic findings, chemoradiothe rapy regimen, and clinical and pathologic stages) were not significantly as sociated with a survival time of 3 years or longer (Fisher exact test, 2-ta iled). Although not significant, p53 mutational status suggested long-term survival. In 11 of 14 patients who are alive with no history of recurrence, p53 genotyping demonstrated no point mutations in 10 patients. Median surv ival time for the long-term survivors has not been reached. Conclusions: Long-term survival can be achieved in patients with esophageal carcinoma who undergo induction chemoradiotherapy and esophagectomy. Recur rence is unlikely in patients who survive for 3 years or longer after under going this multimodality treatment.