Surgery Improves Survival in Stage III-IV Esophageal Cancer
by CD Buckner MD, Medical Editor
Surgery after chemoradiotherapy—which is the standard of care in advanced esophageal cancer—increased overall and disease-free survival compared with chemoradiotherapy alone, according to the results of a study presented at the 2013 Gastrointestinal Cancers Symposium in San Francisco.
The esophagus is a muscular tube that food and liquids pass through on their on their way to the stomach. Each year in the United States, more than 17,000 people are diagnosed with cancer of the esophagus and more than 15,000 die of the disease. Chemoradiotherapy (CRT) followed by surgical resection is the standard of care for treating advanced esophageal cancer. However, the role of surgery has recently been called intow question.
Researchers conducted an analysis comparing outcomes among patients with advanced esophageal cancer treated with CRT with or without surgery. The analysis included 232 patients treated between 2000 and 2011. Participants were predominantly male, had stage III or IV disease, and had tumors that were 5 cm or shorter in length. All patients were treated with CRT (122 without surgery and 110 with surgery).
The analysis indicated that surgery was associated with a significant increase in overall survival and disease-free survival. Among patients who received CRT followed by surgery, 42.3 percent achieved 5-year overall survival compared to 29 percent of patients who had CRT alone. Patients who underwent surgery after CRT were also more likely to have a 5-year disease-free survival compared with those who did not have surgical resection (29% versus 22.8%).
Median overall survival among patients who underwent surgical resection was 42.2 months compared to 20.4 months in those who did not. Median 5-year disease-free survival time was 16.8 months with surgery compared with 8.4 months without. In the multivariate analysis, overall survival was significantly associated with lower disease stage, tumor length of less than 5 cm, and surgery.
The researchers suggest that surgery should be included as part of a tri-modality treatment for advanced esophageal cancer, along with chemotherapy and radiation.
Shridhar R, Freilich J, Hoffe S, et al. Survival in patients with esophageal cancer treated with surgery after chemoradiotherapy. Journal of Clinical Oncology. 2012; 30(suppl 34): Abstract 98.