Patients with locally advanced esophageal carcinoma nonresponder to radiochemotherapy: who will benefit from surgery?

Abstract

In patients who are nonresponders to primary radiochemotherapy (RCT), prognosis is poor, leading mostly to palliation. Salvage surgery may have a survival benefit otherwise complete. Our aim was to identify predictors of R0 resection in these patients. In 98 nonresponders with locally advanced infracarinal tumors, curative salvage surgery was attempted. Resection was R0 in 62.2% and incomplete in 37.8% of cases. Univariate and multivariate analyses included pre-RCT and post-RCT variables collected prospectively. Overall survival was higher in the R0 resection group (18.4 vs 8.6 months, P < .001). Independent predictors of R0 resection were tumor height <or= 5 cm on barium swallow (P = .045) and aortic contact <or= 90 degrees on computed tomography (P = .039) evaluated after RCT. Three groups of patients were constructed: 1, tumor height <or= 5 cm with aortic contact <or= 90 degrees (n = 43); 2, tumor height between 6 and 10 cm with aortic contact <or= 90 degrees (n = 32); and 3, aortic contact > 90 degrees , irrespective of tumor height (n = 23). Rates of R0 resection were 81%, 53%, and 39%, respectively (P = .001). Salvage esophagectomy should be systematically attempted in nonresponders with tumor height <or= 5 cm on barium swallow and aortic contact <or= 90 degrees on computed tomography and discussed case by case for other patients.