Objective: We sought to determine whether chemoradiotherapy after esophagectomy improves survival. Methods: From 1994 to 2000, 31 patients with locoregionally advanced esophageal carcinoma (90% pT3, 81% pN1, and 13% pM1a) received postoperative adjuvant chemoradiotherapy. Concurrently, 52 patients with advanced carcinoma underwent esophagectomy alone and survived at least 10 weeks, the time frame for adjuvant therapy. A propensity score based on demographic, tumor, and surgical factors was used to identify matched pairs to determine the association of adjuvant therapy with outcomes. Results: For patients receiving adjuvant therapy versus esophagectomy alone, risk-unadjusted median, 1-year, and 4-year survivals were 28 versus 14 months, 68% ± 8. 4% versus 60% ± 6.8%, and 44% ± 9.0% versus 17% ± 5.6%, respectively (P = .05). Similarly, risk-unadjusted median time to recurrence was 25 versus 13 months (P = .15), and median recurrence-free survival was 22 versus 11 months (P = .04). Among propensity-matched patients, median, 1-year, and 4-year survivals for those receiving adjuvant therapy versus esophagectomy were 28 versus 15 months, 60% ± 11.0% versus 65 ± 10.7%, and 44% ± 11.3% versus 0% (P = .05). Median time to recurrence was 25 versus 13 months (P = .04), and recurrence-free survival was 22 versus 10 months (P = .02). Conclusion: In patients with locoregionally advanced esophageal carcinoma, addition of postoperative adjuvant chemoradiotherapy to esophagectomy alone doubled survival time, time to recurrence, and recurrence-free survival. Patients with locoregionally advanced carcinoma after esophagectomy should be considered for adjuvant therapy.
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine