Neoadjuvant chemoradiotherapy versus chemotherapy and surgery for patients with locally advanced esophageal squamous cell carcinoma

Background: Neoadjuvant chemoradiotherapy (nCRT) and surgery has been recommended as the standard treatment for locally advanced esophageal carcinoma in western countries. However, neoadjuvant chemotherapy (nCT) rather than nCRT is preferred for a large cohort of patients with locally advanced esophageal squamous cell carcinoma (ESCC) in China to reduce postoperative morbidity. This study aimed to compare the efficacy and postoperative morbidity of nCRT and nCT in patients with locally advanced ESCC. Methods: A total of 111 patients with locally advanced ESCC (T2-4aN0-1M0) received neoadjuvant treatment at our institution from January 2009 to January 2014. Among them, 53 cases received one cycle of nCT with concurrent radiotherapy while the remaining 58 received two cycles of chemotherapy alone before surgery. Results: Pathologic complete response (pCR) was observed in 15 patients in the nRCT group (28.3%) and 8 patients in the nCT group (13.8%, P=0.060). Postoperative morbidity was 32.1% in the nRCT group and 37.9% in the nCT group (P=0.660). Disease-free survival (DFS) rates at 1, 2, 3 years were 73.1%, 66.7%, 53.6% in the nRCT group, and 73.7%, 60.4%, 52.2% in the nCT group, respectively (P=0.848). Overall survival (OS) rates at 1, 2, 3 years were 88.5%, 78.0%, 59.5% in the nRCT group, and 89.5%, 72.9% and 56.2% in the nCT group, respectively (P=0.749). Conclusions: NRCT may achieve higher pCR rate than nCT without increasing the odds of postoperative morbidity, but the survival was similar between two treatment groups.