Trimodality versus Chemo Radiation Therapy Alone: The Role of Surgery in Treatment of Locally Advanced Squamous Cell Carcinoma of the Esophagus

Yaping Xu, Chenxue Jiang, Gang Lin, Xiang Zhu, Shuiyun Han, Xiaojiang Sun, Jinshi Liu, Qixun Chen and Weimin Mao

Department of Radiation Oncology, Zhejiang Cancer Hospital, China
First Clinical Medical School, Wenzhou Medical University, China
Department of Thoracic Surgery, Zhejiang Cancer Hospital, China

^*Correspondance to: Yaping Xu 

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Abstract:

Background and
Purpose: The current practice varies in treatments of locally advanced Squamous Cell Carcinoma (SCC) of esophagus in different countries. This study aimed to compare the results of trimodality therapy with CRT alone in patients with locally advanced resectable SCC.Patients and
Methods: Patients with locally advanced resectable SCC of esophagus were eligible. For trimodality, patients received surgery and preoperative/postoperative chemoradiation. In CRT alone group, patients only received radiation and chemotherapy. Local tumor control, 3-year survival and treatment-related mortality were assessed.Results: 184 consecutive patients were analyzed. 109 were treated with trimodality therapy, 75 received CRT alone depended on patients’ willing. 17.4% of the resected patients in trimodality group had locoreginal recurrent disease versus 30.7% in the CRT alone group (P= 0.036). The 3-year progression-free survival (PFS) was 53.8% versus 33.5% (P= 0.019), and the overall survival (OS) was 51.2% versus 39.8% (P= 0.011), for patients received trimodality and CRT alone, respectively. Treatment-related mortality was 3.7% in trimodality group compared with 1.3% in definitive CRT group (P= 0.650). There was no significant difference in the 3-year OS in patients receiving a 50.4 Gy radiation dose compared with >50.4 Gy radiation dose in CRT alone group (45.3% vs. 36.4%, P = 0.927).Conclusions: Compared with CRT alone, trimodality therapy appeared to have superior local control, PFS and OS, with similar treatment-related mortality for the treatment of patients with SCC of esophagus. The role of surgery could not be replaced by CRT alone, even with increased radiation dose.

Keywords:

Oesophageal squamous cell carcinoma; Trimodality therapy; Preoperative chemoradiotherapy; Postoperative chemoradiotherapy; Definitive chemoradiotherapy

Cite the Article:

Xu Y, Jiang C, Lin G, Zhu X, Han S, Sun X, et al. Trimodality versus Chemo Radiation Therapy Alone: The Role of Surgery in Treatment of Locally Advanced Squamous Cell Carcinoma of the Esophagus. Ann Clin Case Rep. 2018; 3: 1490.