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Thomas W. Rice
Malcolm M. DeCamp
Sudish C. Murthy
Eugene H. Blackstone
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Right arrow Esophagus - cancer

J Thorac Cardiovasc Surg 2003;126:1590-1596
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Benefit of postoperative adjuvant chemoradiotherapy in locoregionally advanced esophageal carcinoma

Thomas W. Rice, MDa,b,*, David J. Adelstein, MDa,c, Mark A. Chidel, MDa,d, Lisa A. Rybicki, MSa,e, Malcolm M. DeCamp, MDa,b, Sudish C. Murthy, MD, PhDa,b, Eugene H. Blackstone, MDa,b,e

a The Center for Swallowing and Esophageal Disorders, The Cleveland Clinic Foundation, Cleveland, Ohio,USA
b Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Department of Hematology and Medical Oncology,, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
d Department of Radiation Oncology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
e Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Read at the Twenty-eighth Annual Meeting of The Western Thoracic Surgical Association, Big Sky, Mont, June 19-22, 2002.

Received for publication June 20, 2002; revisions received August 19, 2002; revisions received March 11, 2003; accepted for publication April 10, 2003.

* Address for reprints: Thomas W. Rice, MD, The Cleveland Clinic Foundation, 9500 Euclid Ave/Desk F25, Cleveland, OH 44195, USA
ricet{at}ccf.org

OBJECTIVE: We sought to determine whether chemoradiotherapy after esophagectomy improves survival.

METHODS: From 1994 to 2000, 31 patients with locoregionally advanced esophageal carcinoma (90% pT3, 81% pN1, and 13% pM1a) received postoperative adjuvant chemoradiotherapy. Concurrently, 52 patients with advanced carcinoma underwent esophagectomy alone and survived at least 10 weeks, the time frame for adjuvant therapy. A propensity score based on demographic, tumor, and surgical factors was used to identify matched pairs to determine the association of adjuvant therapy with outcomes.

RESULTS: For patients receiving adjuvant therapy versus esophagectomy alone, risk-unadjusted median, 1-year, and 4-year survivals were 28 versus 14 months, 68% ± 8.4% versus 60% ± 6.8%, and 44% ± 9.0% versus 17% ± 5.6%, respectively (P = .05). Similarly, risk-unadjusted median time to recurrence was 25 versus 13 months (P = .15), and median recurrence-free survival was 22 versus 11 months (P = .04). Among propensity-matched patients, median, 1-year, and 4-year survivals for those receiving adjuvant therapy versus esophagectomy were 28 versus 15 months, 60% ± 11.0% versus 65% ± 10.7%, and 44% ± 11.3% versus 0% (P = .05). Median time to recurrence was 25 versus 13 months (P = .04), and recurrence-free survival was 22 versus 10 months (P = .02).

CONCLUSION: In patients with locoregionally advanced esophageal carcinoma, addition of postoperative adjuvant chemoradiotherapy to esophagectomy alone doubled survival time, time to recurrence, and recurrence-free survival. Patients with locoregionally advanced carcinoma after esophagectomy should be considered for adjuvant therapy.




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