Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: Analysis of surveillance, epidemiology, and end results database

To determine the value of radiotherapy in addition to esophagectomy for stage II and III TESCC . We searched the Surveillance, Epidemiology, and End Results ( SEER ) database for all cases of stage II ‐ III TESCC . Patients were grouped as those receiving pre‐ or postoperative radiotherapy plus esophagectomy and those receiving esophagectomy alone. Overall survival ( OS ) and cancer‐specific survival ( CSS ) were compared between the groups. Among the 3292 patients, multimodality treatments (pre‐ or postoperative radiotherapy plus surgery) were more effective than surgery alone (5‐year, OS : 17.3% vs 7.9%; P  <   0.001; CSS : 51.8% vs 34.9%; P  <   0.001). Among the patients receiving multimodality treatments, multivariate analyses revealed stage to be the most significant prognostic factor for OS ( II vs III , HR , 0.726; P  <   0.001), but the sequence of radiotherapy and surgery was only of the marginal significance (pre‐ vs postoperative, HR , 0.875; P  =   0.093). Preoperative radiotherapy provided significantly better survival than postoperative radiotherapy in stage III disease (5‐year, OS : 13.0% vs 11.0%, P  <   0.04; CSS : 49.2% vs 31.7%, P  <   0.003), but not in stage II disease (5‐year OS : 23.5% vs 21.0%, P  =   0.519; CSS : 62.0% vs 53.4%, P  =   0.075). Radiotherapy in addition to esophagectomy provides better outcomes than esophagectomy alone for in stage II ‐ III TESCC . Preoperative radiotherapy followed by surgery appears to be the optimal treatment strategy in stage III TESCC .