Is combined chemotherapy and radiation therapy equally effective as surgical resection in localized esophageal carcinoma?

Abstract

This is a retrospective cohort comparison of combined chemotherapy and radiation versus esophagectomy in nonmetastatic esophageal cancers. Between 1984 and 1994, 82 patients received concurrent chemotherapy and radiation as their primary treatment. Their treatment consisted of 50-60 Gy of radiation in 20-30 fractions over 4-6 weeks, concurrent with bolus mitomycin C (8 mg/m2) on day 1, 5-fluorouracil (5-FU) infusion (20 mg/kg/day) +/- leucovorin (20 mg/m2/day) on days 1-4 and 22-25. This group was compared to another cohort of 81 patients who had esophagectomy. Both groups were restaged according to the 1983 AJCC clinical staging system and there was more clinical Stage III disease in the chemoradiation group, 30% versus 16%. The complete response rate was 68% after chemoradiation (by clinical assessment) and 83% for esophagectomy (by pathological assessment). At 5 years, the local relapse rate was 59% for chemoradiation and 51% for esophagectomy. The 5-year disease-free rate and survival were 23% and 25% for chemoradiation, and 21% and 23% for esophagectomy respectively. There was no significant difference in the disease control and survival between the two treatments. The pretreatment AJCC clinical stage was a strong prognosticator of outcome. The 5-year survival was 55% for Stage I, 16% for Stage II, and 8% for Stage III (p = 0.00003). Combined chemotherapy and radiation appeared to be as effective as esophagectomy in localized esophageal cancer.