Chemoradiotherapy versus surgery for clinical stage I esophageal squamous cell carcinoma: A long-term comparison

Background

Definitive chemoradiotherapy (CRT) is an alternative to surgery for stage I esophageal squamous cell carcinoma (ESCC). The aim of this study was to evaluate the long-term outcome of CRT and surgery for stage I ESCC.

Methods

Patients (pts) with clinical stage I (cT1N0M0) ESCC treated with CRT or surgery at Aichi Cancer Center Hospital between January 2003 and September 2012 were retrospectively analyzed. Pts were excluded if they had a history of invasive cancer within 1 year before the treatment.

Results

Among 102 pts included, 63 were treated with CRT (cohort C) and 39 with surgery (cohort S). Although there was a higher proportion of pts with Charlson comorbidity index ≥ 1 (39.7% vs. 23.1%), pack-year history of smoking ≥ 30 (65.1% vs. 48.7%) and a past history of cancer (28.6% vs. 10.3%) in cohort C than in cohort S, no statistically significant difference was observed between the two cohorts with respect to pts’ characteristics. Fifty-nine pts (93.7%) achieved a complete response in cohort C, and R0 resection was performed in all pts in cohort S. Only one treatment-related death was observed in cohort C. Recurrences occurred more frequently in cohort C (40.0% vs. 15.3%), most of which were curatively treated by salvage therapy. With a median follow-up of 6.0 years, the 5-year overall survival rates were 83.9% in cohort C and 89.5% in cohort S (HR = 1.72; 95% CI: 0.65–4.53; P = 0.27). The 5-year disease-specific survival rates were similar in both cohorts (91.8% vs. 88.4%; HR = 1.11; 95% CI: 0.34–3.63; P = 0.87). In cohort C, death due to other causes was frequently observed (12.7% vs. 2.6%); in particular, five pts (7.9%) died of a second primary cancer in other organs (second primary). The rate of second primary was 28.6% in cohort C and 12.8% in cohort S.

Conclusions

Our findings suggest that CRT yields a disease-specific survival comparable to surgery for clinical stage I ESCC due to successful salvage therapy after recurrences. A high incidence of second primary indicates the need for surveillance during long-term follow-up.

Clinical trial identification

Legal entity responsible for the study

None

Funding

Aichi Cancer Center Hospital

Disclosure

All authors have declared no conflicts of interest.