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  • Title: Postoperative radiotherapy improved survival of poor prognostic squamous cell carcinoma esophagus.
    Author: Chen J, Zhu J, Pan J, Zhu K, Zheng X, Chen M, Wang J, Liao Z.
    Journal: Ann Thorac Surg; 2010 Aug; 90(2):435-42. PubMed ID: 20667325.
    Abstract:
    BACKGROUND: The purpose of this study was identify prognostic factors and to investigate the association between postoperative radiotherapy and overall survival of thoracic esophageal squamous cell carcinoma patients. METHODS: From January 1993 to March 2007, 1,715 patients underwent extended esophagectomy with three-field lymph node dissection with or without postoperative radiotherapy and were eligible for analysis. Patients were grouped to surgery only (n = 1,277) and surgery plus postoperative radiotherapy (n = 438). Radiation dose was 50 Gy in 25 fractions. RESULTS: The overall survival rates at 1, 3, 5, and 10 years were 86.6%, 61.3%, 49.4%, and 36.1%, respectively. Univariate and multivariate analyses showed that age 60 years or more, male sex, tumor more than 5 cm long, poorly differentiated histology, T4 tumor, presence of a vascular cancer thrombus in the surgical specimen, lymph node positivity, 3 or more positive lymph nodes, and disease stage II or higher were negative prognostic factors for overall survival. Postoperative radiation therapy improved overall survival for patients with poor disease-related prognostic factors: positive nodal disease, 3 or more positive lymph nodes, stage III/IV, and large or deeply invading tumor. Postoperative radiation had no survival benefit for patients who did not have the poor disease-related prognostic factors. CONCLUSIONS: Postoperative radiotherapy is indicated for patients with poor disease-related prognostic factors.
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