Originally published as JCO Early Release 10.1200/JCO.2005.05.017 on March 21 2005

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Complete Response to Neoadjuvant Chemoradiotherapy in Esophageal Carcinoma Is Associated With Significantly Improved Survival

From the Departments of Surgical Oncology, Medical Oncology, and Radiation Oncology, and Division of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA

Address reprint requests to Melvyn Goldberg, MD, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; e-mail: M_Goldberg{at}fccc.edu

PURPOSE: Attempts to improve survival of patients with esophageal cancer have been made using induction chemoradiotherapy (CRT) followed by surgery. A large single-center experience was reviewed to determine which treatment-related variables could predict survival and recurrence.

PATIENTS AND METHODS: All patients undergoing esophagectomy between January 1994 and December 2002 were reviewed. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazards models, and survival curves were estimated using the Kaplan-Meier method.

RESULTS: Of 171 patients with invasive cancer, 131 (77%) underwent preoperative CRT. The average age was 60 years, and most patients were male (85%). Operations performed included Ivor-Lewis (60%), transhiatal (8%), three-hole (23%), or left thoracoabdominal (8%) esophagectomy. Perioperative mortality rate was 5%. Median overall survival (OS) of the entire group was 33 months, and the 5-year OS rate was 26%. Induction CRT was associated with a 33% 5-year survival rate compared with 11% for surgery alone (P = .43). Patients downstaged to pathologic stage 0 or I had an improved OS and disease-free survival (DFS) compared with those patients who were not downstaged (P = .022). Additionally, the ability to perform an R0 resection was a significant factor for OS and DFS (n = 130; P < .0001 and P <.0002, respectively).

CONCLUSION: Response to CRT and the ability to perform an R0 resection are associated with significantly improved survival in patients with esophageal carcinoma.

Presented in part in poster format at the 1st Annual American Society of Clinical Oncology/Society of Surgical Oncology/American Society for Therapeutic Radiology and Oncology/American Gastroenterological Association Gastrointestinal Symposium, San Francisco, CA, January 22-24, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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