Long-term Survival Following Induction Chemoradiotherapy and Esophagectomy for Esophageal Carcinoma

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Abstract
ESOPHAGEAL cancer is a devastating disease with unacceptably poor long-term survival after radiotherapy and/or surgery. This poor outcome is primarily owing to the biologic predilection of this malignant tumor for early transmural invasion and lymph node metastasis. A 5-year survival rate of 10% or less has been reported in several studies, with a median survival time of approximately 12 months with locoregional therapy.1,2 Current efforts have focused on multimodality therapy to alter the pathogenesis of esophageal carcinoma. Chemoradiotherapy (CRT) before surgical resection theoretically eliminates micrometastases and improves primary tumor resectability. Numerous phase II trials suggest that this approach may improve local-regional control, and select studies have demonstrated prolonged survival in patients undergoing CRT and esophagectomy compared with historical reports of patients treated with esophagectomy alone.3-9 However, a limited number of phase III trials have produced conflicting results, doing little to justify the routine use of preoperative CRT.2,10,11