PURPOSE: The role of neoadjuvant radiotherapy (NeoRT) before definitive surgery for esophageal cancer remains controversial. This study used a large population-based database to assess the effect of NeoRT on survival for patients treated with definitive surgery. METHODS AND MATERIALS: The overall survival (OS) and cause-specific survival for patients with Stage T2-T4, any N, M0 (cT2-T4M0) esophageal cancer who had undergone definitive surgery between 1998 and 2004 were analyzed by querying the Surveillance, Epidemiology, and End-Results database. Kaplan-Meier survival curves were generated and univariate comparisons were made using the log-rank test. Cox proportional hazards survival regression multivariate analysis was performed with NeoRT, T stage (T2 vs. T3-T4), pathologic nodal status (pN0 vs. pN1), number of nodes dissected (>10 vs. </=10), histologic type (adenocarcinoma vs. squamous cell carcinoma), age (<65 vs. >/=65 years), and gender as covariates. RESULTS: A total of 1,033 patients were identified. Of these, 441 patients received NeoRT and 592 underwent esophagectomy alone; 77% were men, 67% had adenocarcinoma, and 72% had Stage T3-T4 disease. The median OS and cause-specific survival were both significantly greater for patients who received NeoRT compared with esophagectomy alone (27 vs. 18 months and 35 vs. 21 months, respectively, p <0.0001). The 3-year OS rate was also significantly greater in the NeoRT group (43% vs. 30%). On multivariate analysis, NeoRT, age <65 years, adenocarcinoma histologic type, female gender, pN0 status, >10 nodes dissected, and Stage T2 disease were all independently correlated with increased OS. CONCLUSION: These results support the use of NeoRT for patients with esophageal cancer. Prospective studies are needed to confirm these results.
PURPOSE: The role of neoadjuvant radiotherapy (NeoRT) before definitive surgery for esophageal cancer remains controversial. This study used a large population-based database to assess the effect of NeoRT on survival for patients treated with definitive surgery. METHODS AND MATERIALS: The overall survival (OS) and cause-specific survival for patients with Stage T2-T4, any N, M0 (cT2-T4M0) esophageal cancer who had undergone definitive surgery between 1998 and 2004 were analyzed by querying the Surveillance, Epidemiology, and End-Results database. Kaplan-Meier survival curves were generated and univariate comparisons were made using the log-rank test. Cox proportional hazards survival regression multivariate analysis was performed with NeoRT, T stage (T2 vs. T3-T4), pathologic nodal status (pN0 vs. pN1), number of nodes dissected (>10 vs. </=10), histologic type (adenocarcinoma vs. squamous cell carcinoma), age (<65 vs. >/=65 years), and gender as covariates. RESULTS: A total of 1,033 patients were identified. Of these, 441 patients received NeoRT and 592 underwent esophagectomy alone; 77% were men, 67% had adenocarcinoma, and 72% had Stage T3-T4 disease. The median OS and cause-specific survival were both significantly greater for patients who received NeoRT compared with esophagectomy alone (27 vs. 18 months and 35 vs. 21 months, respectively, p <0.0001). The 3-year OS rate was also significantly greater in the NeoRT group (43% vs. 30%). On multivariate analysis, NeoRT, age <65 years, adenocarcinoma histologic type, female gender, pN0 status, >10 nodes dissected, and Stage T2 disease were all independently correlated with increased OS. CONCLUSION: These results support the use of NeoRT for patients with esophageal cancer. Prospective studies are needed to confirm these results.
Authors: Loretta Erhunmwunsee; Brian R Englum; Mark W Onaitis; Thomas A D'Amico; Mark F Berry Journal: Ann Surg Oncol Date: 2014-09-19 Impact factor: 5.344
Authors: Stephan Kersting; Ralf Konopke; Dag Dittert; Marius Distler; Felix Rückert; Jörg Gastmeier; Gustavo B Baretton; Hans D Saeger Journal: J Gastroenterol Hepatol Date: 2009-05 Impact factor: 4.029
Authors: P J Speicher; X Wang; B R Englum; A M Ganapathi; B Yerokun; M G Hartwig; T A D'Amico; M F Berry Journal: Dis Esophagus Date: 2014-09-12 Impact factor: 3.429
Authors: M Worni; A W Castleberry; B Gloor; R Pietrobon; J C Haney; T A D'Amico; I Akushevich; M F Berry Journal: Dis Esophagus Date: 2013-08-13 Impact factor: 3.429