Neoadjuvant Chemotherapy in Esophageal Cancer: Single Institution Experience

Background: Esophageal cancer is a major clinical problem that has a generally poor prognosis. As a result, there has been interest in combining surgery with neoadjuvant chemotherapy in an attempt to improve clinical outcomes. Evidence for clinical benefit from preoperative chemotherapy exists but it is not clear which patients (stage, tumor location, and histology) will benefit the most from this preoperative treatment. Methods: This study retrospectively analyzed the outcome of 71 patients with operable esophageal carcinoma treated at Northamptonshire Oncology Centre, UK from January 2001 until July 2008. Patients were treated with two cycles of neoadjuvant chemotherapy followed by surgery. Data were analyzed by Kaplan-Meier plots, Cox regression modeling and chi-squared test. Results: Median patient’s age was 64 years. Male patients represented 83% of the cases. Of patients, 63% had an ECOG performance status of 1. Surgical resection was done for 63 (88.7%) patients. Two year overall survival in this cohort was 5.6%. Univariate analysis identified only surgical resection to be associated with better prognosis (P<0.0001). Multivariate analysis identified surgical resection (P<0.0001) and pathology type (P=0.007) to be the significant independent prognostic factors for survival. Conclusion: In this retrospective study, survival data for operable esophageal cancer is poor despite the use of neoadjuvant chemotherapy. Lack of a dedicated upper gastrointestinal surgeon and unavailability of PET scan staging during the study period might have attributed to the poor outcome.