Retrospective Review of Patients With Locally Advanced Esophageal Cancer Treated at the University of Pittsburgh

Objectives: The management of locally advanced esophageal cancer is controversial. Treatment options include neoadjuvant chemotherapy or chemoradiation therapy (CRT) followed by definitive surgery or definitive chemoradiation. A single center experience was reviewed to determine the oncologic outcomes of these 3 approaches. Methods: We retrospectively reviewed records of 100 patients with adenocarcinoma and squamous cell carcinoma of the esophagus of which 22 patients received neoadjuvant chemotherapy, 49 patients received neoadjuvant CRT, and 18 patients received definitive CRT. The majority of patients underwent minimally invasive esophagectomy (74%). The mean follow-up was 34 months (median, 22 mo; range, 1 to 180 mo). Results: Median survival of the entire group was 22.9 months [95% confidence interval (CI) 19.3-30.4]. The 2-year and 5-year overall survival rates were 47.9% and 23.2%, respectively. Median survival of patients who received neoadjuvant chemotherapy, neoadjuvant CRT, and definitive CRT was 31.9 (95% CI 21.2-51.5), 28.7 (95% CI 20.2-40.7), and 8.9 (95% CI 5.7-14.4) months, respectively. Patients who received neoadjuvant CRT were more likely to have pathologic complete response (pCR) (20%) compared with patients who received neoadjuvant chemotherapy alone (0%; P = 0.04). The 2-year and 5-year overall survival rates of patients with pCR were 75% and 50%, respectively. Conclusions: There was no survival benefit or differences in failure pattern seen among the 3 treatment approaches in this series. However, patients who received neoadjuvant CRT were more likely to have pCR and these patients showed a trend toward improved survival.