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Long-term Survival Following Induction Chemoradiotherapy and Esophagectomy for Esophageal Carcinoma
John I. Lew, MD;
William E. Gooding, MS;
Ulysses Ribeiro, Jr, MD;
Adriana V. Safatle-Ribeiro, MD;
Mitchell C. Posner, MD
Arch Surg. 2001;136:737-742.
Hypothesis Long-term survival is rare in patients treated for esophageal carcinoma. Several clinical trials suggest the possibility of prolonged survival in patients who undergo induction chemoradiotherapy plus esophagectomy.
Design Prospective uncontrolled study.
Setting University hospital.
Patients and Methods Forty-four patients with carcinoma of the esophagus or gastroesophageal junction were prospectively entered into a phase II trial of preoperative 5-fluorouracil, cisplatin, and interferon alfa with concurrent external beam radiotherapy before esophagectomy. Curative resection was performed on 36 of 41 patients who completed the induction chemoradiotherapy.
Results Of the 44 patients, 17 are alive at a median follow-up of 50 months. Of these 17 patients, 15 show no evidence of recurrent disease. Of the 14 patients with long-term survival ( 3 years), 1 patient died of disease, and another patient is alive with disease. The remaining 12 patients are alive and disease-free (median follow-up, 54 months). Six patients have survived longer than 4 years and 3 patients longer than 5 years. Subsequent primary tumors have developed in 2 patients. One patient had a recurrence at 11 months following initiation of treatment and remains disease-free 43 months postresection of a single brain metastasis. Standard clinicopathologic parameters (age, sex, histologic findings, chemoradiotherapy regimen, and clinical and pathologic stages) were not significantly associated with a survival time of 3 years or longer (Fisher exact test, 2-tailed). Although not significant, p 53 mutational status suggested long-term survival. In 11 of 14 patients who are alive with no history of recurrence, p53 genotyping demonstrated no point mutations in 10 patients. Median survival time for the long-term survivors has not been reached.
Conclusions Long-term survival can be achieved in patients with esophageal carcinoma who undergo induction chemoradiotherapy and esophagectomy. Recurrence is unlikely in patients who survive for 3 years or longer after undergoing this multimodality treatment.
From the Department of Surgery, The University of Chicago Hospitals and the Pritzker School of Medicine, Chicago, Ill (Drs Lew and Posner); Department of Biostatistics, The University of Pittsburgh School of Medicine, Pittsburgh, Pa (Dr Gooding); and the Departments of Surgery and Medicine, The University of São Paolo, São Paolo, Brazil (Drs Ribeiro and Safatle-Ribeiro).
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