Stage III esophageal adenocarcinoma: definitive chemoradiation vs. chemoradiation plus surgery

The optimal management of patients with locally advanced esophageal cancer remains under debate. We aimed to compare the long-term survival outcomes between definitive chemoradiation (dCR) and chemoradiation plus surgery (CRS) in patients with stage III esophageal adenocarcinoma (EAC). Using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program registry, adults (18years old) with diagnosis of AJCC 6th edition stage III EAC (T3/N1, T4/N0, and T4/N1) between 2004 and 2014 were included. A multivariable Cox regression was used to assess the effect of dCR and CRS on mortality. Of the 2633 patients included, 1115 (42%) underwent Dcr, and 1518 (58%) underwent CRS. The 5-year survival rate was 13% for patients undergoing dCR and 27% for patients undergoing CRS (p<0.0001). Our observational data suggest that patients with stage III EAC may benefit by the use of esophagectomy after chemoradiotherapy.