2005 Abstracts: Neoadjuvant Chemoirradiation Compared with Definitive Chemoirradiation As a Curative Therapy for Squamous-Cell Carcinoma Of the Esophagus:A Case Control Study
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Neoadjuvant Chemoirradiation Compared with Definitive Chemoirradiation As a Curative Therapy for Squamous-Cell Carcinoma Of the Esophagus:A Case Control Study
Frances K. Cheung, Department of Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong, Hong Kong; Philip W. Chiu, Angus C. Chan, Wilfred L. Mui, Prince of Wales Hospital, Hong Kong, Hong Kong, Hong Kong; Alex Au-yeung, Prince of Wales Hospital, Hong Kong, Hong Kong; Candice Lam, Enders K. Ng, Prince of Wales Hospital, Hong Kong, Hong Kong, Hong Kong
Background
Squamous cell carcinoma of esophagus carried a poor prognosis, and surgical treatment alone resulted in a 5 year survival of 10-15%. Recently, chemoirradiation was introduced as a noeadjuvant mode of therapy. From our pilot study, definitive chemoirradiation can achieve complete response without surgery. The risk and benefit of immediate esophagectomy after chemoirradiation or definitive chemoirradiation for esophageal cancer has not been elucidated. Patients and Methods From August 1997 to March 2000, 23 patients with CT staging of T2/3, N0/1 mid or lower third squamous cell cancer of esophagus were treated with esophagectomy after neoadjuvant chemoirradiation. The treatment regime included two 21-day cycles of continous 5FU infusion, cisplatin 50mg/m2 on D1 and D22 and concurrent radiotherapy of 50Gy. Between November 1998 to September 2003, 46 patients with similar tumor stage received definitive chemoirradiation and salvage esophagectomy if there was residual or local recurrent disease. These two treatment groups were compared in terms of operative morbidities, 30 days peri-operative mortality, recurrence rate, 3 year and 5 year survival. Results There was no difference between the two treatment groups in terms of age, baseline demographics and tumor stage. There was more lower third tumor in the neoadjuvant group (82%vs 30%). The median follow up in the neoadjuvant group was 77 months (66 to 89) while that of the definitive chemoradiotherapy group was 41 months (23 to 68). For the neoadjuvant group, after esophagectomy a complete pathological response was detected in 7 patients (30%). The peri-operative mortality was 13% and the morbidity was 53%. For the definitive chemoirradiation group, four patients were found to have residual disease and were treated with salvage esophagectomy (9%). There was no mortality in the definitive chemoirradiation group. There was no difference between the 2 groups in 3-year (48% in neoadjuvant vs 52%in definitive, log rank test p=0.22) and 5-year survival (35% vs 37%, p=0.43) (Fig 1). Conclusions Definitive chemoirradiation offered a similar survival as compared to neoadjuvant chemoirradiation and esophagectomy in squamous cell carcinoma of esophagus.
Figure 1 Survival curve of the neoadjuvant group and definitive group
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