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Factors predictive of survival for esophageal carcinoma treated with preoperative radiotherapy with or without chemotherapy followed by surgery
Author(s) -
Yeh Alexander M.,
Mendenhall William M.,
Morris Christopher G.,
Zlotecki Robert A.,
Desnoyers Rodwige J.,
Vogel Stephen B.
Publication year - 2003
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.10233
Subject(s) - medicine , radiation therapy , chemotherapy , univariate analysis , multivariate analysis , carcinoma , surgery , survival analysis , esophageal cancer , oncology , cancer
Purpose To evaluate parameters that may influence prognosis in patients treated with preoperative radiotherapy (RT) or chemoradiation. Methods and Materials One hundred seventy‐six patients with esophageal carcinoma received preoperative radiotherapy (45 patients) or chemoradiation (131 patients). Forty‐three received no surgery (NS), 32 had exploratory surgery (ES), and 101 received definitive surgery (DS). Results Five‐year cause‐specific survival and absolute survival rates were overall, 19% and 16%; NS group, 0% and 0%; ES group, 3% and 3%; DS group, 30% and 26%. On univariate analysis, definitive surgery ( P < 0.0001), tumor size less than 5 cm ( P < 0.0001), and chemotherapy ( P = 0.0015) were significant predictors of improved cause‐specific survival. Cause‐specific survival was 51% for tumors ≤3 cm (n = 33), 32% for 3.1 to 4 cm (n = 28), and 16% for 4.1 to 5 cm (n = 29). No patient with a tumor ≥6 cm (n = 86) survived. Multivariate analysis of the DS group showed complete or partial pathologic response ( P = 0.0001), chemotherapy ( P = 0.0026), and overall treatment time less than 3 months ( P = 0.0405) significantly predicted improved cause‐specific survival. Tumor <5 cm was marginally significant ( P = 0.0515). Conclusion Patients who undergo preoperative chemoradiation and definitive surgery have improved survival. J. Surg. Oncol. 2003;83:14–23. © 2003 Wiley‐Liss, Inc.