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

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Acknowledgment

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. This study was supported in part by the Liu Bie Ju Cha and Family Fellowship in Cancer (DC) and the Blue Dot Fund (AK).

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Authors and Affiliations

  1. Department of Radiation Oncology, Stanford University and Cancer Center, Stanford, CA, USA

    Julian C. Hong MS, James D. Murphy MD, MA, Albert C. Koong MD, PhD & Daniel T. Chang MD

  2. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Julian C. Hong MS

  3. Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA

    James D. Murphy MD, MA

  4. Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, USA

    Samuel J. Wang MD, PhD

Authors
  1. Julian C. Hong MS
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  2. James D. Murphy MD, MA
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  3. Samuel J. Wang MD, PhD
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  4. Albert C. Koong MD, PhD
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  5. Daniel T. Chang MD
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Correspondence to Daniel T. Chang MD.

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Hong, J.C., Murphy, J.D., Wang, S.J. et al. Chemoradiotherapy Before and After Surgery for Locally Advanced Esophageal Cancer: A SEER-Medicare Analysis. Ann Surg Oncol 20, 3999–4007 (2013). https://doi.org/10.1245/s10434-013-3072-9

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  • DOI: https://doi.org/10.1245/s10434-013-3072-9

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