The researchers investigated the role of surgery and postoperative adjuvant therapy in patients with lymph-node-positive esophageal carcinoma.
They reported their findings in the current issue of Cancer.
A retrospective review of all patients with resected esophageal carcinoma (n = 165), between 1991 and 1997, was performed.
Lymph-node-positive (N1) patients, who received concurrent or sequential postoperative radiotherapy (50 grays) and chemotherapy (cisplatin, 5-fluorouracil with or without epirubicin), were compared with N1 patients who underwent surgery alone.
Disease-free and overall survival rates were calculated, and groups were compared.
28 N1 patients underwent surgery alone (S group). 38 N1 patients underwent surgery and also received postoperative chemoradiation therapy (CRT group).
|Median survival after treatment:|
Surgery and chemoradiation:
Between the groups, preoperative risk factors, tumor characteristics, Eastern Cooperative Oncology Group (ECOG) scores, and lengths of hospital stay were similar.
The researchers found that the disease-free survival rates were also similar (S group, 10.6 months; CRT group, 10.2 months). However, the S group had more local disease recurrences (S group, 35%; CRT group, 13%).
The overall survival rate, according to the Kaplan-Meier analysis, showed a significant survival advantage with postoperative CRT radiation. The median overall survival for the CRT group was 47.5 months, which was significantly longer than that of the S group (14.1 months).
On univariate analysis, the ECOG score, T status, and treatment received were all found to influence survival significantly.
In the multivariate model, postoperative CRT was a predictor of survival (risk ratio for mortality, 0.35). It was correlated with a significantly decreased risk of death in patients with lymph-node-positive resected esophageal carcinoma.
Dr Eric L. R. Bédard, of the University of Western Ontario, London, Ontario, concluded on behalf of fellow authors, "Postoperative chemoradiation therapy appears to prolong survival in patients with lymph node positive, resected esophageal carcinoma."