A comparison of survival with chemoradiation therapy alone versus surgery and post-esophagectomy chemoradiation in patients with esophageal carcinoma

Background: Esophageal cancer is usually incurable. Aggressive treatments involving multimodality therapies have been offered to improve overall survival rates. It seems that various therapeutic approaches can have a different outcome and survival. The aim of our study was to compare survival with chemoradiation therapy (CRT) alone versus surgery and post-esophagectomy chemoradiation therapy (CRT-S) in patients with esophageal carcinoma. Methods: This historical cohort study assigned 226 patients with stage I to III esophageal cancer who referred to Radio-oncology clinic of Razi hospital from 2005-2011 for oncology treatment. Patients were categorized into two groups. One group treated by chemoradiation therapy (CRT) alone and other group treated with surgery and post-esophagectomy chemoradiation. Overall survival of two groups was compared. For statistical analysis SPSS was used and the comparison of groups was performed with Kaplan-Meier analysis and Log-rank test. Results: Of 266 patients with stage I to III esophageal cancer, 222 patients were in the CRT group and 44 patients were in the CRT-S group. 22 patients had stage I, 82 had stage II and 118 had stage III. Median survival was 17 month for the CRT group and 18 month for the CRT-S group. There was no significant difference in survival rate between chemoradiation therapy alone (CRT) and post-esophagectomy chemoradiation therapy (CRT-S) (P>0.005). Conclusion: Based on these data, we concluded that patients with tumors, especially of squamous cell carcinoma, that respond to initial chemoradiotherapy did not derive any survival benefit from subsequent surgery and three-month mortality was significantly higher in the surgery group. Surgery imposes a major emotional trauma and an excessive and unnecessary cost on the patient and the community health system. We conclude that it is better to use CRT for patients with non-advanced esophageal cancer.