Rational application of preoperative or postoperative chemoradiotherapy (CRT) can provide a benefit in progression-free survival and overall survival in patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC), according to a study published April 7 in the World Journal of Gastroenterology.
Jin Lv, from the department of surgery of the Affiliated Nanjing First Hospital of Nanjing Medical University and Oncology Center in Nanjing, Jiangsu Province, China, and colleagues investigated the role of perioperative CRT in the treatment of locally advanced thoracic ESCC and compared the results of preoperative and postoperative CRT to surgery alone in patients with resectable ESCC in their prospective study.
Between January 1997 and June 2004, 238 patients with stage II-III ESCC were enrolled using preoperative CT-based staging criteria. After receiving informed consent, patients were randomized into three groups: preoperative CRT, 80 cases; postoperative CRT, 78 cases; and surgery-only, 80 cases.
According to the authors, progression-free survival was chosen as the primary endpoint by treatment arm measured from study until documented progression of disease or death from any cause and the one, three, five and 10-year survival rates were followed up. The secondary endpoint was overall survival determined by the time, marked by months, between the date of therapy and the date of death. Other objectives included surgical and adjuvant therapy complications, they wrote.
Utilizing an average follow-up time of 45 months for all study participants, the authors noted significant differences in the one, three, five and 10-year overall survival rates for overall survival compared to progression-free survival for preoperative CRT, postoperative CRT and surgery-only.
For preoperative CRT, overall survival rates for one, three, five and ten years were 91.3, 63.5, 43.5 and 24.5 percent compared to 91, 62.8, 42.3, 24.4 percent, for postoperative CRT, and 87.5, 51.3, 33.8, 12.5 percent for the surgery-only group, reported Lv and colleagues. For progression-free survival, rates of 89.3, 61.3, 37.5, 18.1 percent were noted for noted for preoperative CRT, 89.1, 61.1, 37.2, 17.8 percent for postoperative CRT and 84.5, 49.3, 25.9, 6.2 percent for surgery-only for the one, three, five and 10-year follow-up marks.
“There were no significant differences in overall survival and progression-free survival between the preoperative CRT and postoperative CRT arm,” the authors wrote. “For the patients who had radical resection, significant differences in median progression-free survival (48 months vs. 61 months vs. 39.5 months) and median overall survival (56.5 months vs. 72 months vs. 41.5 months) were detected among the three arms.”
In addition, they noted that the local recurrence rates in the preoperative CRT, postoperative CRT group and S group were 11.3, 14.1 and 35 percent, respectively. While significant differences were not detected among the three groups when comparing complications, the research tended to be in favor of the postoperative CRT and surgery-only groups.The authors said that their results show that long-term survival is maximized by the use of CRT followed by surgery for locally advanced ESCC, but patients are more likely to develop toxicity.
“As therapies improve, it is likely that the toxicity may be reduced and neoadjuvant CRT may provide a more marked benefit in esophageal cancer. Meanwhile, postoperative CRT can also be safely administered and considered as the multimodal treatment of choice for locally advanced ESCC,” they wrote.