Attempts to improve survival of patients with esophageal cancer have been made using induction chemoradiotherapy followed by surgery.
Dr Melvyn Goldberg and colleagues from Philadelphia reviewed a large single-center experience variables that could predict survival and recurrence.
The research team reviewed all patients who underwent esophagectomy between 1994 and 2002.
|Perioperative mortality rate was 5% with a median overall survival of 33 months|
|Journal of Clinical Oncology|
Univariate and multivariate analyses were performed using log-rank and Cox proportional hazards models.
The team estimated survival curves using the Kaplan-Meier method.
The researchers reported that of 171 patients with invasive cancer, 131 underwent preoperative chemoradiotherapy.
The average age of patients was 60 years, and 85% of patients were male.
The team noted that operations performed included Ivor-Lewis at 60%, transhiatals at 8%, three-hole at 23%.
The team observed that the other operation performed was left thoracoabdominal esophagectomy at a rate of 8%.
Perioperative mortality rate was 5% and the median overall survival of the entire group was 33 months, whilst the 5-year overall survival rate was 26%.
The researchers found that induction chemoradiotherapy was associated with a 33% 5-year survival rate compared with 11% for surgery alone.
Patients downstaged to pathologic stage 0 or I had an improved overall survival and disease-free survival compared with those who were not downstaged.
Additionally, the team found that the ability to perform an R0 resection, or tumor free margin resection, was a factor for overall survival and disease free survival.
Dr Goldberg's team concludes, “Response to chemoradiotherapy and the ability to perform an R0 resection are associated with significantly improved survival in patients with esophageal carcinoma.”