Patients with cervical esophageal cancer who underwent primary radiotherapy experienced similar rates of failure-free survival and OS as those who underwent primary surgery, according to results of a retrospective study.
The results suggest primary radiotherapy should be performed first in this patient population, researchers concluded.
The ideal management approach of cervical esophageal cancer has not been established. Radiotherapy is associated with lower rates of acute morbidity and mortality compared with surgery, and it also offers potential for larynx preservation. After surgery, however, the transposed stomach may demonstrate better long-term function than an irradiated esophagus, according to background information provided by researchers.
Cai Neng Cao, MD, of the department of radiation oncology at Cancer Hospital at the Chinese Academy of Medical Sciences and Peking Union Medical College in China, and colleagues evaluated outcomes of 224 patients with cervical esophageal cancers who underwent primary radiotherapy for primary surgery between 2001 and 2012.
The analysis included 161 patients who underwent primary radiotherapy with or without subsequent surgery. That group included 133 who received radiotherapy alone or radiotherapy with concurrent chemotherapy, as well as 28 patients who underwent preoperative radiotherapy followed by surgery.
The other 63 patients in the analysis underwent primary surgery with or without subsequent radiotherapy. These included 27 patients who underwent surgery alone, as well as 36 patients who underwent surgery followed by postoperative radiotherapy.
Key endpoints included 2-year local failure-free survival (FFS), regional FFS, distant FFS and OS.
Outcomes were similar between the primary radiotherapy and primary surgery groups with regard to local FFS (69.9% vs. 68.6%), regional FFS (79.5% vs. 69.8%), distant FFS (74.3% vs. 62.5%) and OS (49.3% vs. 50.7%; P>.05 for all).
Results of a separate analysis using matched cases between primary radiotherapy and primary surgery groups demonstrated no significant survival differences between treatment groups.
“Given the similarities in rates of local FFS, regional FFS, distant FFS, and overall survival between the primary radiotherapy and primary surgery cervical esophageal cancer treatment groups, we recommend primary radiotherapy for larynx preservation, with surgery offered subsequently for patients who do not respond to radiotherapy,” Cao and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.