This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (8)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Radiation Therapy  • Surgical Oncology  • Thoracic Surgery  • Alert me on articles by topic

Experience at a Single Institution

S. Christopher Malaisrie, MD; Brian Untch, BA; Gerard V. Aranha, MD, FRCS; Najeeb Mohideen, MD; Alexander Hantel, MD; Jack Pickleman, MD

Arch Surg. 2004;139:532-539.

Hypothesis  Patients receiving neoadjuvant chemoradiotherapy followed by surgery (CRS) undergo downstaging of their tumor and have improved survival when compared with patients undergoing surgery followed by adjuvant chemoradiotherapy (SCR).

Design  Retrospective study.

Setting  Tertiary-care university medical center.

Patients  One hundred twenty-three patients with squamous cell carcinoma and adenocarcinoma of the esophagus underwent Ivor-Lewis esophagectomy from January 1, 1990, through December 31, 2001. Of these, 31 received CRS; 27, SCR; and 65, surgery alone.

Interventions  Patients were candidates for neoadjuvant or adjuvant therapy if they had locally advanced disease (T3/T4 N0 or any T stage with N1). Neoadjuvant and adjuvant therapies were nonrandomized and based on the preference of the treating oncologist and surgeon.

Main Outcome Measurements  Pathological downstaging was analyzed in the patients receiving CRS. Operative mortality, postoperative morbidity, median survival, and overall survival were compared between the CRS and SCR groups.

Results  Pathological downstaging (as characterized by TNM staging) was observed in 20 (64%) of the patients receiving CRS. Complete pathological responses occurred in 5 (16%) of the patients undergoing CRS. No 30-day mortality was observed in either treatment group. No statistical difference in survival was observed between groups, although a trend suggested improved survival with neoadjuvant therapy (3-year survival in CRS and SCR groups was 45% and 22%, respectively; P = .15). Complete pathological responders in the CRS group had a 1-year survival of 80% compared with 29% in nonresponders (P = .25). No statistical differences were observed between groups in relation to blood loss, length of hospital stay, mortality, or morbidity.

Conclusions  Neoadjuvant chemoradiotherapy effectively downstages cancer in patients with locally advanced esophageal disease. Morbidity and operative mortality were not significantly different between patients receiving neoadjuvant and adjuvant therapy. The difference in overall survival between the 2 groups did not reach statistical significance, although a trend at 3 years was observed.

From the Section of Surgical Oncology, Department of Surgery (Drs Malaisrie, Aranha, and Pickleman and Mr Untch), the Department of Radiation Oncology (Dr Mohideen), and the Division of Hematology/Oncology, Department of Medicine (Dr Hantel), Stritch School of Medicine, Loyola University Medical Center, Maywood, Ill.

RELATED ARTICLE

This Month in Archives of Surgery
Arch Surg. 2004;139(5):465.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

An audit of surgical outcomes of esophageal squamous cell carcinoma
Goan et al.
Eur. J. Cardiothorac. Surg. 2007;31:536-544.
ABSTRACT | FULL TEXT  

Prophylaxis against carcinogenesis in three kinds of unestablished tumor models via IL12-gene-engineered MSCs
Chen et al.
Carcinogenesis 2006;27:2434-2441.
ABSTRACT | FULL TEXT  

Endoscopic ultrasonography-identified celiac adenopathy remains a poor prognostic factor despite preoperative chemoradiotherapy in esophageal adenocarcinoma
Malaisrie et al.
J. Thorac. Cardiovasc. Surg. 2006;131:65-72.
ABSTRACT | FULL TEXT