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SAN FRANCISCO -- The standard of care in advanced esophageal cancer treatment -- surgery after chemoradiotherapy -- increased overall and disease-free survival compared with chemoradiotherapy alone, researchers reported here.

Among patients with advanced disease who received chemoradiotherapy followed by surgical resection, 42.3% achieved 5-year overall survival (OS) versus 29% who achieved 5-year OS after chemoradiotherapy only (P=0.0003), according to Ravi Shridhar, PhD, of the Moffitt Cancer Center in Tampa, Fla., and colleagues.

Patients who underwent surgery after chemoradiotherapy were also more likely to have a 5-year disease-free survival (DFS) compared with those who did not have surgical resection (29% versus 22.8%, P<0.0001), Shridhar said in a poster session at the Gastrointestinal Cancers Symposium.

The authors noted that recent studies have questioned the standard of care for treating advanced esophageal cancer and decided to compare outcomes in 232 patients who received chemoradiation with and without surgery at their institution between 2000 and 2011.

Participants were predominantly male, had stage III or IV disease, and had tumors that were 5 cm or shorter in length.

Median OS among patients who underwent surgical resection was 42.2 months versus 20.4 months in those who did not. Median 5-year DFS time was 16.8 months with surgery versus 8.4 months without.

In the multivariate analysis, OS was significantly associated with the following:

• Lower disease stage (P=0.0098)
• Tumor length of less than 5 cm (P=0.0059)
• Surgery (P<0.0001)

Also in the multivariate analysis, 5-year DFS was associated with:

• Tumor length of less than 5 cm (P=0.0112)
• Surgery (P=0.0007)
• Radiation technique (P=0.0023)

Additionally, there was a trend for an association between 5-year DFS and lower disease stage (P=0.069) and squamous histology (P=0.055).

Finally, the authors reported that age, gender, and radiation dose were not prognostic for DFS. All of those factors, plus histology, tumor location, and radiation technique were not prognostic for OS.

They recommended that surgery be included as part of trimodality treatment for advanced esophageal cancer.

Shridhar also noted that future studies could include a longer follow-up of patients with squamous cell carcinomas "to better qualify the initial negative results," and that randomized trials are needed to address the role of surgery for adenocarcinomas.

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