Choice of first line treatment for esophageal cancer from the perspective of clinical outcomes of definitive chemoradiotherapy and surgery alone

Successful definitive chemoradiotherapy (CRT) has the remarkable benefit of organ preservation and achieves good quality of life for esophageal cancer patients. We started CRT plus salvage treatment for resectable cases from October 2001, and compared clinical outcomes to patients who had undergone surgery alone in the same period. Over all survival rates of CRT+salvage and surgery showed no significant difference at any cancer staging. In contrast, the majority of patients with cStage I and IIB had continuous complete response (CR) after CRT and the benefit of esophageal preservation. However, a number of patients with cStage IIA and III had residual diseases after CRT, so salvage surgery was needed as second line therapy. Our results indicate that cStage I and IIB has a good indication for CRT, but radical esophagectomy is recommended for cStage IIA and III patients as first line treatment. (author)