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Postchemoradiation Resected Locally Advanced Esophageal and Gastroesophageal Junction Carcinoma: Long-Term Outcome With or Without Intraoperative Radiotherapy

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

Abstract

Background

To report feasibility, tolerance, anatomical topography of locoregional recurrence (LRR), and long-term outcome for esophageal and esophagogastric (EG) cancer patients treated with preoperative chemoradiation (CRT) and surgery with or without a radiation boost of intraoperative electron beam radiotherapy (IOERT).

Methods

From January 1995 to December 2010, 53 patients with primary esophageal (n = 26; 44 %) or EG carcinoma (n = 30; 56 %), and disease confined to locoregional area [clinical stage: IIb (n = 30; 57 %), IIIa (n = 14; 26 %), IIIb (n = 6; 11 %), IIIc (n = 3; 6 %)], were treated with preoperative CRT, curative (R0) resection with an extended (two-field) lymph node dissection in all cases. Thirty-seven patients also received a preanastomotic reconstruction IOERT boost (applicator diameter size 6–9 cm, dose 10–15 Gy, beam energy 6–15 MeV) over the tumor bed in the mediastinum and upper abdominal lymph node area.

Results

With a median follow-up time of 27.9 months (range, 0.2–148), LRR rate was 15 % (n = 8). Five-year overall survival (OS) and disease-free survival was 48 and 36 %, respectively. Univariate log-rank analyses showed that receiving IOERT was associated with lower risk of LRR (p = 0.004). On multivariate analysis, only the IOERT group retained significance in relation to LRR (odds ratio, 0.08; 95 % confidence interval, 0.01–0.48; p = 0.01). Postoperative mortality and perioperative complications were 11 % (n = 6) and 30 % (n = 16).

Conclusions

Local control is high in the radiation-boosted area, but OS remains modest, given the high risk of distant metastases. Intensified locoregional treatment needs to be tested in the context of more efficient concurrent, neo-, and adjuvant systemic therapy.

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Acknowledgment

Supported in part by a grant from the Health Institute of Research Carlos III, Spanish Ministry of Science and Innovation (project code PI11-02908).

Conflict of interest

The authors declare no potential and real commercial conflicts of interest.

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Authors and Affiliations

  1. Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Felipe A. Calvo MD, PhD & Claudio V. Sole MD

  2. School of Medicine, Complutense University, Madrid, Spain

    Felipe A. Calvo MD, PhD, Claudio V. Sole MD, Rosángela Obregón MD, PhD & Jose Luis García-Sabrido MD, PhD

  3. Service of Radiation Oncology, Instituto de Radiomedicina, Santiago, Chile

    Claudio V. Sole MD

  4. Service of General Surgery III, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Rosángela Obregón MD, PhD, Luis Gonzalez-Bayon MD, PhD & Jose Luis García-Sabrido MD, PhD

  5. Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Marina Gómez-Espí MD & Miguel A. Lozano MD

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  1. Felipe A. Calvo MD, PhD
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  2. Claudio V. Sole MD
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  3. Rosángela Obregón MD, PhD
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  4. Marina Gómez-Espí MD
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  6. Luis Gonzalez-Bayon MD, PhD
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Corresponding author

Correspondence to Felipe A. Calvo MD, PhD.

Additional information

Felipe A. Calvo and Claudio V. Sole contributed equally to the manuscript.

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Calvo, F.A., Sole, C.V., Obregón, R. et al. Postchemoradiation Resected Locally Advanced Esophageal and Gastroesophageal Junction Carcinoma: Long-Term Outcome With or Without Intraoperative Radiotherapy. Ann Surg Oncol 20, 1962–1969 (2013). https://doi.org/10.1245/s10434-012-2810-8

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  • DOI: https://doi.org/10.1245/s10434-012-2810-8

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