Long-term results of resected esophageal cancer with complete remission to pre-operative chemoradiation.

Introduction : Improvements of the results of combined chemoradiotherapy (CRT) in esophageal cancer has led several groups to adopt a non surgical attitude specially in case of complete response (endoscopy +/- biopsy). Few information are available about the follow-up of these patients. We studied long-term results of 35 patients who underwent resection after complete response to preoperative chemoradiotherapy. Patients and methods. 161 patients with resecable carcinoma of the thoracic esophagus have received the same protocol of CRT (cisplatin 80 mg/m(2), radiation therapy split course: 37,5 Gy) all patients were followed every for 4 months (no lost of view). Results: Complete response (endoscopy and biopsy) was obtained for 35 patients (21,7 %). 19 of them (54 %) had pathologic complete response (PCR) (no tumor in the specimen), 16 have microscopic foci of residual tumor (46 %). The overall 5-year survival rate was 49,8 % for the whole group (median survival 64 months), 70 % for the group without tumor in the specimen, 48 % for the group with microscopic foci of residual tumor (NS). Conclusions: One half of the complete response (endoscopy + biopsy) have not a pathologic complete response (microscopic foci of residual tumor in the specimen). The 49,8 % five year survival suggests a benefit from esophagectomy for complete response after combined chemoradiotherapy.