Squamous cell carcinoma of the esophagus

The role of surgery as primary treatment for patients with squamous cell carcinoma of the esophagus (SCCE) has been challenged by an improved response rate for radiotherapy that is made possible by adding radiosensitizing chemotherapy. The purpose of our study was to review our institution's treatment results for SCCE and to compare results of radiation versus surgery as primary treatment of early stage disease. A retrospective chart review was done on 241 patients who were treated with SCCE at Kansas University Medical Center and affiliated hospitals between 1970 and 1990. Patients were divided into five groups based on treatment received: (A) No Treatment; (B) Surgery Only; (C) Surgery plus Adjuvant Chemoradiotherapy; (D) Radiation Therapy Only; and (E) Chemoradiotherapy. Surgical treatment groups B and C had the best overall survival of all groups. To reduce any bias due to stage differences in groups, survival of groups was assessed only for early stage disease patients (Stage I, IIa, IIb). For Stage I and II patients receiving surgery as primary treatment (groups B and C), 29 per cent had a survival at 5 years compared to patients receiving primary radiation treatment (groups D and E) who had a combined survival of only four per cent. Although attempting comparison of risk groups is always a problem in nonrandomized studies, it is significant that only one 5-year survivor was in the nonresection radiation treatment groups D and E. Surgical resection for SCCE had the best survival in our study, especially in patients with early stage disease.