Annals of Surgical Oncology

, Volume 20, Issue 12, pp 3999–4007

Chemoradiotherapy Before and After Surgery for Locally Advanced Esophageal Cancer: A SEER-Medicare Analysis

Authors

  • Julian C. Hong
    • Department of Radiation OncologyStanford University and Cancer Center
    • University of Wisconsin School of Medicine and Public Health
  • James D. Murphy
    • Department of Radiation OncologyStanford University and Cancer Center
    • Department of Radiation Medicine and Applied SciencesUniversity of California San Diego
  • Samuel J. Wang
    • Department of Radiation MedicineOregon Health and Science University
  • Albert C. Koong
    • Department of Radiation OncologyStanford University and Cancer Center
    • Department of Radiation OncologyStanford University and Cancer Center
Thoracic Oncology

DOI: 10.1245/s10434-013-3072-9

Cite this article as:
Hong, J.C., Murphy, J.D., Wang, S.J. et al. Ann Surg Oncol (2013) 20: 3999. doi:10.1245/s10434-013-3072-9

Abstract

Purpose

The optimal combination and timing of therapy for esophageal cancer remains controversial. The Surveillance, Epidemiology, and End Results (SEER)-Medicare registry was used to assess neoadjuvant and adjuvant therapy.

Methods

Patients diagnosed with nonmetastatic T3+ or N1+ esophageal adenocarcinoma (ACA) or squamous cell carcinoma (SCC) from 1995 to 2002 who underwent surgical resection within 6 months of diagnosis were studied. Medicare data defined preoperative chemoradiotherapy (preCRT), preoperative radiotherapy (preRT), postoperative CRT (postCRT), chemotherapy and surgery (CT + S), and surgery alone.

Results

Of 419 eligible patients, 126 received preCRT, 55 preRT, 40 postCRT, 29 CT + S, and 169 surgery alone. PreCRT yielded median overall survival (OS) of 37 months, greater than surgery alone (17 months, p = 0.002) and postCRT (17 months, p = 0.06). PreRT (20 months, p = 0.20), postCRT (p = 0.88), and CT + S (20 months, p = 0.42) were not associated with OS benefit versus surgery alone. For SCC, preCRT improved survival versus surgery alone (p = 0.01), with a trend for ACA (p = 0.07). ACA (22 months) had greater OS than SCC (17 months) (p = 0.03). ACA, younger age, and married status were associated with increased OS. Adjusting for these, preCRT had longer OS versus surgery alone (p = 0.02) and postCRT (p = 0.03). Chemotherapy agents and surgical approach did not affect OS.

Conclusions

In the SEER-Medicare cohort, preCRT significantly improved survival versus surgery alone and postCRT for locally advanced esophageal cancer, particularly for SCC. PreRT, postCRT, and CT + S were not associated with longer survival.

Copyright information

© Society of Surgical Oncology 2013