TRIMODALITY TREATMENT OF LOCALLY ADVANCED, RESECTABLE ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A SINGLE INSTITUTE EXPERIENCE IN SOUTHERN TAIWAN

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Abstract

Background

Patients with esophageal squamous cell carcinoma have a poor prognosis. An esophagectomy with lymph node dissection was the standard treatment in the past, but preoperative chemoradiotherapy followed by surgery (trimodality) has become more common in clinical practice recently. The aim of this study is to report the treatment outcome and post-operative mortality/morbidities of these two treatment modalities in patients with locally advanced, resectable esophageal squamous cell carcinoma.

Methods

Between January 1991 and December 2010, 102 patients with locally advanced, resectable stage (T3N0-1) esophageal squamous cell carcinoma who received trimodality treatment or surgery alone were identified. There were 41 patients in the trimodality group and 61 patients in the group of surgery alone. The outcome and post-operative complications were compared between the trimodality group and the surgery-alone group.

Results

The median follow-up from the time of diagnosis of the esophageal cancer was 15.0 months. A univariate analysis showed that treatment after 2003 (P < 0.001), trimodality therapy (P = 0.006) and female sex (P = 0.017) were predictive of better disease-free survival and overall survival. In multivariate comparison, trimodality therapy (P = 0.006) and female sex (P = 0.040) represented the independent predictive factors of longer survival. Post-operative mortality and morbidities were similar between these two groups. In 41 patients receiving trimodality therapy, 8 (20%) patients achieved a complete pathologic response after preoperative chemoradiotherapy and had significantly superior overall survival (P = 0.034) and disease-free survival (P = 0.022).

Conclusions

Retrospective and non-randomized nature of this study did not allow comparison of trimodality therapy with surgery alone, the similar post-operative complications between surgery alone and trimodality groups, together with the improved survival in patients receiving trimodality therapy would support the need for additional prospective randomized, controlled trial.

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