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Patients with Locally Advanced Esophageal Carcinoma Nonresponder to Radiochemotherapy: Who Will Benefit From Surgery?

¹ Department of Digestive and Oncological Surgery, University Hospital Claude Huriez—Centre Hospitalier Régional Universitaire, Lille, France
² University of Lille II, Lille, France

Correspondence: Address correspondence and reprint requests to: Christophe Mariette; E-mail: c-mariette{at}chru-lille.fr

Background: In patients who are nonresponders to primary radiochemotherapy (RCT), prognosis is poor, leading mostly to palliation. Salvage surgery may have a survival benefit otherwise complete. Our aim was to identify predictors of R0 resection in these patients.

Methods: In 98 nonresponders with locally advanced infracarinal tumors, curative salvage surgery was attempted. Resection was R0 in 62.2% and incomplete in 37.8% of cases. Univariate and multivariate analyses included pre-RCT and post-RCT variables collected prospectively.

Results: Overall survival was higher in the R0 resection group (18.4 vs 8.6 months, P < .001). Independent predictors of R0 resection were tumor height 5 cm on barium swallow (P = .045) and aortic contact 90° on computed tomography (P = .039) evaluated after RCT. Three groups of patients were constructed: 1, tumor height 5 cm with aortic contact 90° (n = 43); 2, tumor height between 6 and 10 cm with aortic contact 90° (n = 32); and 3, aortic contact > 90°, irrespective of tumor height (n = 23). Rates of R0 resection were 81%, 53%, and 39%, respectively (P = .001).

Conclusion: Salvage esophagectomy should be systematically attempted in nonresponders with tumor height 5 cm on barium swallow and aortic contact 90° on computed tomography and discussed case by case for other patients.

Key Words: Esophageal carcinoma • Treatment • Radiochemotherapy • Salvage surgery

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