Original article: general thoracic
Value of radiotherapy after radical surgery for esophageal carcinoma: a report of 495 patients

https://doi.org/10.1016/S0003-4975(02)04401-6Get rights and content

Abstract

Background

Despite three decades of debate, no conclusion has been reached concerning the effectiveness of postoperative radiotherapy for resected esophageal carcinoma. From 1986 through 1997, a prospective randomized study was carried out with 495 patients in an attempt to define the value of this therapeutic modality.

Methods

A total of 495 patients with esophageal cancer who had undergone radical resection were randomized by the envelope method into a surgery-alone group (S) of 275 patients and a surgery plus radiotherapy group (S + R) of 220 patients. Radiation treatment was started 3 to 4 weeks after the operation. The portals encompassed the entire mediastinum and bilateral supraclavicular areas. A midplane dose of 50 to 60 Gy in 25 to 30 fractions was delivered over 5 to 6 weeks.

Results

The overall 5-year survival rate was 31.7% for the S group and 41.3% (p = 0.4474) for the S + R group. The 5-year survival rates of patients who were lymph node positive were 14.7% and 29.2% (p = 0.0698), respectively. Five-year survival rates of stage III patients were 13.1% and 35.1% (p = 0.0027), respectively.

Conclusions

Postoperative prophylactic radiotherapy improved the 5-year survival rate in esophageal cancer patients with positive lymph node metastases and in patients with stage III disease compared with similar patients who did not receive radiation therapy. These results were almost significant for patients with positive lymph node metastases and highly significant for patients with stage III disease.

Section snippets

Material and methods

From September 1986 through December 1997, 495 patients with esophageal carcinoma who had undergone radical resection were divided into two groups: a surgery-alone group (S) of 275 patients and a surgery plus radiotherapy group (S + R) of 220 patients. Randomization was carried out weekly at a joint conference of physicians in the Departments of Thoracic Surgical Oncology, Radiation Oncology, Imaging, Pathology, andMedical Oncology. All patients with esophageal cancer who had undergone radical

Survival rates

Overall 1-, 3-, 5-, and 10-year survival rates were 79.3%, 47.1%, 39.4%, and 29.8% respectively. Five-year survival rates of stage I and IIa patients and stage IIb and III patients were 52.3% and 28%, respectively (Fig 1). This difference was significant (p = 0.0000).

The 1-, 3-, and 5-year survival rates of the S and S + R groups (excluding the 54 patients excluded from the S + R group) were 79.1%, 43.5%, and 37.1% for the S group and 79.3%, 50.9%, and 41.3% for the S + R group (Fig 2). These

Coment

Preoperative irradiation therapy is an accepted modality in the treatment of esophageal cancer. The therapy is thought to improve resection rates, increase survival rates, and decrease lymph node metastases 1, 2, 3. In contrast, our series of patients who underwent surgery plus postoperative radiotherapy had an overall 5-year survival rate (39.4%) that was higher than the 5-year survival rates in two other studies (23% and 29.6%) 4, 5. Our results are similar to those of three other studies

Acknowledgements

We thank Joe McLaughlin, MD, for his kind revision, especially of the English syntax.

References (11)

  • Z.X. Zhang et al.

    Evaluation of preoperative radiotherapy for esophageal carcinoma—report on 1012 patients

    Chin J Radiat Oncol

    (1992)
  • G.J. Huang et al.

    Experience with combined preoperative irradiation and surgery for carcinoma of the esophagus

    Chinese Med J

    (1981)
  • W. Mei et al.

    Prospective randomized trial on preoperative radiotherapy for esophageal carcinoma

    Chin J Radiat Oncol

    (2001)
  • M.B. Orringer et al.

    Transhiatal esophagectomyclinical experience and refinements

    Ann Surg

    (1999)
  • G.J. Huang et al.

    Surgery of esophageal cancer. Long-term follow-up studies

    Zhonghua Wai Ke Za Zhi

    (1987)
There are more references available in the full text version of this article.

Cited by (225)

View all citing articles on Scopus
*

Dr Yang passed away on August 4, 2000.

View full text