Induction chemoradiotherapy followed by esophagectomy for advanced squamous cell carcinoma of the esophagus

Purpose Chemoradiotherapy (CRT) has been performed for locally advanced thoracic esophageal carcinoma. To evaluate the outcome of induction CRT followed by esophagectomy, we compared it with that of definitive CRT. Patients Of 121 patients with T3-T4 squamous cell carcinoma who received CRT, 39 patients received induction CRT (total, 30-50 Gy) followed by esophagectomy and 82 patients received definitive CRT (> 50 Gy), including the 30 patients who underwent salvage esophagectomy. Methods We reviewed the data of response to CRT, outcome of esophagectomy, survival, and recurrence sites. Results Pathological findings of response to induction CRT revealed pathological complete response (pCR) (grade 3) in 9 patients (23%), partial response (pPR) (grade 2) in 17 patients (45%), and no response (pSD) (grade 1/0) in 13 patients (33%). Clinical response evaluation of definitive CRT showed that 31 (38%) patients achieved CR, 49 incomplete response/stable disease, and 2 progressive disease. Although the induction group was significantly superior to the definitive group in terms of local progression survival (P = 0.0063), no difference was shown in overall survival between the two groups. Salvage esophagectomy for locoregional recurrence significantly improved survival after definitive CRT. There was no difference in postoperative survival between the patients who underwent esophagectomy after induction CRT and those who underwent salvage esophagectomy. Long-term survivors in the definitive CRT group frequently suffered from cardiopulmonary diseases or recurrence. Conclusions Induction CRT followed by esophagectomy showed superior results compared with definitive CRT in local progression but no difference in overall survival.