Radiat Oncol J.  2015 Mar;33(1):12-20. 10.3857/roj.2015.33.1.12.

Treatment outcomes of neoadjuvant concurrent chemoradiotherapy followed by esophagectomy for patients with esophageal cancer

• Kim YH
• Song SY
• Shim HJ
• Chung WK
• Ahn SJ
• Yoon MS
• Jeong JU
• Song JY
• Nam TK

• KMID: 1789152
• DOI: http://doi.org/10.3857/roj.2015.33.1.12

Abstract

PURPOSE
To evaluate treatment outcomes and determine prognostic factors in patients with esophageal cancer treated with esophagectomy after neoadjuvant chemoradiotherapy (NCRT).
MATERIALS AND METHODS
We retrospectively evaluated 39 patients with esophageal cancer who underwent concurrent chemoradiotherapy followed by esophagectomy between 2002 and 2012. Initial clinical stages of patients were stage IB in 1 patient (2.6%), stage II in 5 patients (12.9%), and stage III in 33 patients (84.6%).
RESULTS
The median age of all the patients was 62 years, and the median follow-up period was 17 months. The 3-year overall survival (OS) rate was 33.6% in all the patients. The 3-year locoregional recurrence-free survival (LRFS) rate was 33.7%. In multivariate analysis with covariates of age, the Eastern Cooperative Oncology Group performance status, hypertension, diabetes mellitus, tumor length, clinical response, clinical stage, pathological response, pathological stage, lymphovascular invasion, surgical type, and radiotherapy to surgery interval, only pathological stage was an independent significant prognostic factor affecting both OS and LRFS. The complications in postoperative day 90 were pneumonia in 9 patients, anastomotic site leakage in 3 patients, and anastomotic site stricture in 2 patients. Postoperative 30-day mortality rate was 10.3% (4/39); the cause of death among these 4 patients was respiratory failure in 3 patients and myocardial infarction in one patient.
CONCLUSION
Only pathological stage was an independent prognostic factor for both OS and LRFS in patients with esophageal cancer treated with esophagectomy after NCRT. We could confirm the significant role of NCRT in downstaging the initial tumor bulk and thus resulting in better survival of patients who gained earlier pathological stage after NCRT.

Keyword

Esophageal cancer; Chemoradiotherapy; Esophagectomy; Neoadjuvant therapy

MeSH Terms

Cause of Death
Chemoradiotherapy*
Constriction, Pathologic
Diabetes Mellitus
Esophageal Neoplasms*
Esophagectomy*
Follow-Up Studies
Humans
Hypertension
Mortality
Multivariate Analysis
Myocardial Infarction
Neoadjuvant Therapy
Pneumonia
Radiotherapy
Respiratory Insufficiency
Retrospective Studies