Results of chemoradiotherapy for stage I esophageal cancer in medically inoperable patients compared with results in operable patients. Issue 5 (23rd August 2012) - Jingu, K.
Summary The purpose of the present study was to evaluate long‐term results of chemoradiotherapy for clinical T1b‐2N0M0 esophageal cancer and to compare outcomes for operable and inoperable patients. Patients with stage I esophageal cancer (Union for International Cancer Control [UICC] 2009), excluding patients with cT1a esophageal cancer, were studied. All patients had histologically proven squamous cell carcinoma. Operable patients received cisplatin and 5‐fluorouracil with concurrent radiotherapy of 60 Gy including a 2‐week break. Inoperable patients received nedaplatin and 5‐fluorouracil with concurrent radiotherapy of 60–70 Gy without a pause. End‐points were overall survival rate (OS), cause‐specific survival rate (CSS), progression‐free survival rate (PFS), and locoregional control rate (LC). Thirty‐seven operable patients and 30 medically inoperable patients were enrolled. There was a significant difference in only age between the operable group and inoperable group (P = 0.04). The median observation period was 67.9 months. In all patients, 5‐year OS, CSS, PFS, and LC were 77.9%, 91.5%, 66.9%, and 80.8%, respectively. Comparison of the operable group and inoperable group showed that there was a significant difference in OS (5‐year, 85.5% vs. 68.7%, P = 0.04), but there was no difference in CSS, PFS, or LC. Grade 3 or more late toxicity according to Common Terminology Criteria for Adverse Events v 3.0 was found in seven patients. Even in medically inoperable patients with stage I esophageal cancer, LC of more than 80% can be achieved with chemoradiotherapy. However, OS in medically inoperable patients is significantly worse than that in operable patients.