Effect of chemoradiation followed by surgery on outcomes compared to definitive chemoradiation in locally advanced esophageal squamous cell carcinoma: A single-center experience.

Abstract

e16129 Background: Esophageal squamous cell carcinoma (ESCC) constitutes a major health problem in eastern Turkey, which is a part of a high-incidence area. Chemoradiation without surgery is one of the accepted approaches for treating stage II/III ESCC, but the benefit of adding surgery to chemoradiation remains controversial. Methods: We identified 54 patients with locally advanced ESCC from our database. We analyzed the association of surgery with progression free survival (PFS) and overall survival (OS). Results: Most patients (52%) were female, and 11% were never smokers. Of the cohort, 24 patients underwent chemoradiation followed by surgery, while 30 were treated with definitive chemoradiation. The median OS for all patients was 19.9 months (95% CI: 0.7-39.0). The median PFS was significantly longer for patients treated with surgery (67.6 months, 95% CI: 17.8-117.4) compared to those treated without surgery (9.2 months, 95% CI: 4.9-13.4, p = 0.007). Similarly, the median OS was 72.1 months (95% CI: 24.9-119.2) for patients treated with surgery compared to 16.6 months (95% CI: 7.2-25.9) for those treated without surgery (p = 0.009). Conclusions: Our data demonstrate that chemoradiation followed by surgery provides better outcomes compared to definitive chemoradiation in patients with locally advanced ESCC. Definitive chemoradiation should be reserved for patients who are not surgical candidates due to personal preference or comorbidities.