Radio(chemo)therapy Plus Resection Versus Radio(chemo)therapy Alone for the Treatment of Stage III Esophageal Cancer*

Abstract

MD-RCT plus resection resulted in better LC than HD-RCT alone. If R0 resection is possible, MD-RCT plus resection appears preferable, as it results in better outcome. If only R1/2 resection can be performed, HD-RCT alone appears preferable regarding outcome and the greater morbidity associated with resection.

Impact of Radiotherapy, Chemotherapy and Surgery in Multimodal Treatment of Locally Advanced Esophageal Cancer

“…In view of the high proportion of advanced disease (87% T3/4 tumors) and positive lymph nodes (79%), this result is remarkable. In fact, the baseline characteristics of our patients were poorer than reported by other institutional series [10][11][12]14] . With respect to our CRT group, the OS and LRC rates are better than those achieved in the ran- domized and non-randomized part of the RTOG 8501 study [2] .…”

“…CRT performed in accordance to RTOG 8501 (RT dose range 59.4-66.6 Gy) has been compared to CRT plus surgery (RT dose range 41.4-50.4 Gy) in one other single analysis [12] . Further available reports are characterized by differing radiotherapy schedules [10,16] or variable chemotherapy regimens with lower cumulative cisplatin doses or even without cisplatin [11,14,16] .…”

“…15.0 Gy) [7] , the German trial scheduled induction chemotherapy with cisplatin, etoposide and 5-FU followed by CRT in standard fractionation (40.0 Gy) concomitant to cisplatin and etoposide [8] . Likewise, several institutional reviews reported on differing CRT regimens with or without surgery [10][11][12] .…”

Phase I Study of Definitive Radio-chemotherapy with Cisplatin, 5-Fluorouracil and Cetuximab for Unresectable Locally Advanced Esophageal Cancer

“…If a R0-resection appears unlikely, radio-chemotherapy should be continued and given as definitive treatment, since neoadjuvant radio-chemotherapy plus incomplete (R1/2) resection resulted in worse outcomes than definitive radiochemotherapy alone. In this retrospective study, the 1-year survival rates were 90% after neoadjuvant radiochemotherapy (41.4-50.4 Gy) plus R0-resection, 22% after neoadjuvant radio-chemotherapy plus R1/2-resection and 47% after definitive radio-chemotherapy (59.4-66.6 Gy), respectively (16). The 1-year rates of locoregional control were 94%, 19% and 52%, respectively.…”

“…The decisions with respect to appropriate treatment approach are often made on an individualized basis taking into account several factors, including the patient's age, general condition and comorbidities. According to a retrospective study of 148 patients, the best results for patients with locally advanced disease are achieved with neoadjuvant radio-chemotherapy plus microscopically complete (R0) resection (16). If a R0-resection appears unlikely, radio-chemotherapy should be continued and given as definitive treatment, since neoadjuvant radio-chemotherapy plus incomplete (R1/2) resection resulted in worse outcomes than definitive radiochemotherapy alone.…”