Neoadjuvant Chemoradiotherapy With Surgery Versus Surgery Alone For Patients With Locally Advanced Esophageal Squamous Cell Carcinoma

Objective:To explore the value of neoadjuvant chemoradiotherapy in combination surgery in the treatment of patients with locally advanced esophageal squamous cell carcinoma(ESCC).Methods:From July 2011 to August 2013,patients with locally advanced ESCC treated with neoadjuvant chemoradiotherapy with surgery(treatment group,n=50),or surgery alone(control group,n=50)were retrospectively analyzed.In the study group,all patients received three-dimensional conformal radiotherapyor intensity modulated radiotherapy,a dose of 41.4 Gy(1.8Gy/fraction,5 days a week)started on the first day of chemotherapy(docetaxel 25mg/m~2+cisplatin 25mg/m~2,d1、d8、d15、d22).Esophagectomy with three-field lymph node dissection was carried out approximately 4-5 weeks after completion of neoadjuvant chemoradiotherapy.The Kaplan–Meier survival analysis was performed to compare the overall survival(OS)between the two groups.Results:A total of 100 patients met the study criteria,including 50 patients received neoadjuvant chemoradiotherapy followed by surgery,and 50 underwent surgicalresection alone.The pathological complete response was achieved in 20%(10/50)patients.The most common major hematologic toxic effects in the treatment group were leukopenia(8%);the most common major non-hematologic toxic effects were esophagitis(4%)and vomiting(2%).Post-operative complications were similar in the two groups.Median overall survival was 33 months in the treatment group versus 21months in the control group.Overall survival was significantly better in the treatment group than in the control group(P=0.033)Conclusion:Neoadjuvant chemoradiotherapy in combination surgery could decrease the local recurrence rate and improve overall survival for patients with locally advanced ESCC.