Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma

Abstract

Aim: To investigate the role of perioperative chemoradiotherapy (CRT) in the treatment of locally advanced thoracic esophageal squamous cell carcinoma (ESCC).

Methods: Using preoperative computed tomography (CT)-based staging criteria, 238 patients with ESCC (stage II-III) were enrolled in this prospective study between January 1997 and June 2004. With informed consent, patients were randomized into 3 groups: preoperative CRT (80 cases), postoperative CRT (78 cases) and surgery alone (S) (80 cases). The 1-, 3-, 5- and 10-year survival were followed up. Progression-free survival (PFS) was chosen as the primary endpoint by treatment arm measured from study entry until documented progression of disease or death from any cause. The secondary endpoint was overall survival (OS) determined as the time (in months) between the date of therapy and the date of death. Other objectives were surgical and adjuvant therapy complications.

Results: With median follow-up of 45 mo for all the enrolled patients, significant differences in the 1-, 3-, 5-, 10-year OS (91.3%, 63.5%, 43.5%, 24.5% vs 91%, 62.8%, 42.3%, 24.4% vs 87.5%, 51.3%, 33.8%, 12.5%, P = 0.0176) and PFS (89.3%, 61.3%, 37.5%, 18.1% vs 89.1%, 61.1%, 37.2%, 17.8% vs 84.5%, 49.3%, 25.9%, 6.2%, P = 0.0151) were detected among the 3 arms. There were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). For the patients who had radical resection, significant differences in median PFS (48 mo vs 61 mo vs 39.5 mo, P = 0.0331) and median OS (56.5 mo vs 72 mo vs 41.5 mo, P = 0.0153) were detected among the 3 arms, but there were no significant differences in OS and PFS between the preoperative CRT and postoperative CRT arm (P > 0.05). The local recurrence rates in the preoperative CRT, postoperative CRT group and S group were 11.3%, 14.1% and 35%, respectively (P < 0.05). No significant differences were detected among the 3 groups when comparing complications but tended to be in favor of the postoperative CRT and S groups (P > 0.05). Toxicities of CRT in the preoperative or postoperative CRT arms were mostly moderate, and could be quickly alleviated by adequate therapy.

Conclusion: Rational application of preoperative or postoperative CRT can provide a benefit in PFS and OS in patients with locally advanced ESCC.

Figure 1

Kaplan-Meier curves. A: Postoperative progression-free survival. Logrank test: χ² = 8.39, P = 0.0151; “+”: Loss to follow-up. Preoperative vs surgery: χ² = 6.81, P = 0.0091; Postoperative vs surgery: χ² = 5.38, P = 0.0203; Preoperative vs postoperative: χ² = 0.14, P = 0.7060; B: Postoperative overall survival. Logrank: χ² = 8.07, P = 0.0176; “+”: Loss to follow-up. Preoperative vs surgery: χ² = 7.85, P = 0.0051; Postoperative vs surgery: χ² = 5.33, P = 0.0209; Preoperative vs postoperative: χ² = 0.46, P = 0.4978; C: Postoperative progression-free survival of radical resection. Logrank: χ² = 6.82, P = 0.0331; “+”: Loss to follow-up. Preoperative vs surgery: χ² = 6.16, P = 0.0130; Postoperative vs surgery: χ² = 4.02, P = 0.0449; Preoperative vs postoperative: χ² = 0.22, P = 0.6416; D: Postoperative overall survival of radical resection. Logrank: χ² = 8.36, P = 0.0153; “+”: Loss to follow-up. Preoperative vs surgery: χ² = 7.65, P = 0.0057; Postoperative vs surgery: χ² = 4.78, P = 0.0288; Preoperative vs postoperative: χ² = 0.16, P = 0.6873.