Benefit of Postoperative Multimodality Therapy in Patients with Locally Advanced Esophageal Cancer

Objective: This pilot study was conducted to evaluate the efficacy and toxicity of a three-step combination therapy for locally advanced esophageal cancer. Patients and Methods: Sixty patients with T3-4 and N0-l esophageal carcinoma from a number of institutions were retrospectively enrolled in the study. All patients underwent single-stage curative en bloc esophagectomy. All patients underwent a curative resection with a margin negative for malignant cells. The patients were then assigned into one of two treatment groups based on treatment consisting of either postoperative concurrent chemoradiotherapy (CCRT) with weekly cisplatin 30 mg/m^2 followed by systemic adjuvant chemotherapy (four monthly cycles of cisplatin 20 mg/m^2 and 5-fluorouracil 1000 mg/m^2 for five consecutive days), or postoperative radiation alone. The radiotherapy dose was 55-60 Gy for all patients. Study end points included survival rate, median survival, toxicity, and prognostic efficacy. Results: A total of 60 patients (n=30 per group) were enrolled in this study. The two groups were generally comparable for patient characteristics and hematological and non-hematological toxicities. The CCRT with weekly cisplatin was well tolerated, with significantly better median survival, (20.5 vs 10.0 months) and three-year overall survival (66.7% vs 29.6%, p＜0.05) demonstrated for members of this treatment group compared to the radiation alone group. In the current study, low histological grading (p＜0.001) and tumor size ≤ 4.3 cm (p=0.009) were associated with favorable survival in these patients with locally advanced disease. Conclusions: For locally advanced esophageal cancer, the combination of esophagectomy, postoperative CCRT with weekly cisplatin and systemic adjuvant chemotherapy may be well tolerated and effective. A large-scale, prospective randomized trial of this regimen is being conducted.