Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;155(6):2710-2721.e3.
doi: 10.1016/j.jtcvs.2018.01.086. Epub 2018 Feb 15.

Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by surgery for stage II to III esophageal squamous cell carcinoma

Arianna Barbetta  1 , Meier Hsu  2 , Kay See Tan  2 , Dessislava Stefanova  1 , Koby Herman  1 , Prasad S Adusumilli  1 , Manjit S Bains  1 , Matthew J Bott  1 , James M Isbell  1 , Yelena Y Janjigian  3 , Geoffrey Y Ku  3 , Bernard J Park  1 , Abraham J Wu  4 , David R Jones  1 , Daniela Molena  5
Affiliations

Definitive chemoradiotherapy versus neoadjuvant chemoradiotherapy followed by surgery for stage II to III esophageal squamous cell carcinoma

Arianna Barbetta et al. J Thorac Cardiovasc Surg. 2018 Jun.

Abstract

Objective: Definitive chemoradiotherapy (CRT) remains the most commonly used treatment for locally advanced esophageal squamous cell carcinoma (SCC), because of perceptions that esophagectomy offers an unclear survival advantage. We compare recurrence, overall survival (OS), and disease-free survival (DFS) in patients treated with definitive CRT or neoadjuvant CRT followed by surgery (trimodality).

Methods: This was a retrospective cohort study of patients with stage II and III SCC of the middle and distal esophagus in patients who completed CRT. Treatment groups were matched (1:1) on covariates using a propensity score-matching approach. The effect of trimodality treatment, compared with definitive CRT, on OS, DFS, and site-specific recurrence was evaluated as a time-dependent variable and analyzed using Cox regression with a gamma frailty term for matched units.

Results: We included 232 patients treated between 2000 and 2016: 124 (53%) with definitive CRT and 108 (47%) with trimodality. Trimodality was used less frequently over time (61% before 2009 and 29% after 2009; P < .0001). After matching, each group contained 56 patients. Median OS and DFS were 3.1 and 1.8 years for trimodality versus 2.3 and 1.0 years for CRT. Surgery was independently associated with improved OS (hazard ratio, 0.57; 95% confidence interval, 0.34-0.97; P = .039) and DFS (hazard ratio, 0.51; 95% confidence interval, 0.32-0.83; P = .007).

Conclusions: CRT followed by surgery might decrease local recurrence and increase DFS and OS in patients with esophageal SCC. Until better tools to select patients with pathological complete response are available, surgery should remain an integral component of the treatment of locally advanced esophageal SCC.

Keywords: definitive chemoradiotherapy; esophageal squamous cell carcinoma; esophagectomy, recurrence; neoadjuvant treatment; pathological complete response; trimodality treatment.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Overall survival, stratified according to treatment
Figure 2
Figure 2
Kaplan-Meier curve demonstrating disease-free survival, stratified by treatment group
Figure 3
Figure 3
Cumulative incidence of local recurrence
Figure 4
Figure 4
Cumulative incidence of regional (a) and distant (b) recurrence
Figure 5
Figure 5. Central picture
Overall survival stratified according to treatment
None
Daniela Molena, MD, discussing the implications of the study
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84. - PubMed
    1. Van Heijl M, van Lanschot JJ, Koppert LB, van Berge Henegouwen MI, Muller K, Steyeberg EW, et al. Neoadjuvant chemoradiation followed by surgery versus surgery alone for patients with adenocarcinoma or squamous cell carcinoma of the esophagus (CROSS) BMC Surg. 2008;8:21. - PMC - PubMed
    1. National Comprehensive Cancer Network. [Accessed March 2017];NCCN Guidelines for Treatment of Cancer by Site: Esophageal Cancer [online]. Version 1.2017. Available at: http://www.nccn.org/professionals/default.aspx.
    1. Molena D, Miloslawa S, Blackford AL, Lidor AO. Esophageal cancer treatment is underutilized among elderly patients in the USA. J Gastrointest Surg. 2017;21(1):126–36. - PMC - PubMed
    1. Molena D, Sun HH, Badr AS, Mungo B, Sarkaria IS, Adusumilli PS, et al. Clinical tools do not predict pathological response in patients with esophageal squamous cell cancer treated with definitive chemoradiotherapy. Dis Esophagus. 2014;27:355–9. - PubMed

MeSH terms