Chemotherapy, Chemoradiotherapy May Improve Esophageal Cancer Survival

Compared with surgery alone, treatment with preoperative chemoradiotherapy and/or perioperative chemotherapy has shown longer survival in patients with esophageal cancer.

Among patients with adenocarcinoma of the esophagus and esophagogastric junction (AEG), preoperative chemoradiotherapy (CRT, treatment with both chemotherapy and radiation therapy before surgery) and preoperative and/or perioperative (both preoperative and postoperative treatment) chemotherapy have been found to be associated with longer survival than treatment with surgery alone, researchers have reported.

Researchers analyzed the data of 2,549 patients with nonmetastatic, untreated, resectable AEG from 17 studies conducted from 1989 to 2016 to establish these findings, which have been published in JAMA Network Open.

Regarding overall survival (OS; the time a patient lives, regardless of disease status), CRT plus surgery resulted in a 25% lower risk of death than undergoing surgery alone, with a three-year difference of 105 deaths per 1,000 patients. Likewise, preoperative and/or perioperative chemotherapy plus surgery had a 22% lower risk of death than surgery alone, with a three-year difference of 90 deaths per 1,000 patients.

The two treatment approaches, researchers noted, resulted in similar overall survival, with a three-year difference of only 15 deaths per 1,000 patients for CRT.

“Findings … suggest that both preoperative CRT plus surgery and preoperative and/or perioperative chemotherapy plus surgery are associated with longer survival of patients with AEG compared with surgery alone,” researchers wrote. “No differences between the effect of the two modalities could be found. The association might be mediated through tumor downstaging and a higher probability of complete resection.”

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With regard to disease-free survival (DFS, the time a patient lives without any signs or symptoms of cancer), patients who were treated with preoperative and/or perioperative chemotherapy plus surgery had a 27% lower risk of disease progression or death than those who underwent surgery, while those who received preoperative CRT and surgery had a 26% lower risk of disease progression or death than patients who underwent surgery.

Researchers further reported that both preoperative and/or perioperative chemotherapy plus surgery and perioperative CRT plus surgery were also associated with longer distant recurrence-free survival (RFS, the time a patient lives until cancer spreads to a distant part of the body).

The analysis, researchers wrote, “shows that both preoperative CRT plus surgery and preoperative and/or perioperative chemotherapy plus surgery are associated with longer OS, DFS and distant RFS compared with surgery alone.”

Future research, the study authors noted, “should focus on identifying specific groups of patients in whom one of the two modalities could be more effective, and on the integration of checkpoint inhibitors and targeted therapies into preoperative treatment schemes.”

There will be, according to the American Cancer Society, approximately 22,370 new cases of esophageal cancer diagnosed in the United States and about 16,130 deaths from esophageal cancer in the country in 2024. The lifetime risk of esophageal cancer in the United States is approximately 1 in 127 in men and 1 in 434 in women, the American Cancer Society stated.

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According to the authors of the study, in 2020, with 544,100 deaths, esophageal cancer ranked sixth in mortality worldwide. For patients with AEG who undergo upfront surgery, five-year survival rates are 36.9% for patients with node-negative disease and 9.6% for patients with node-positive disease.

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