Before Is Better Than After Surgery

Esophageal cancer best treated with radiotherapy given before surgery

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Doctors have known for a while that radiation given in addition to chemotherapy and surgery helps esophageal cancer patients live longer. What hasn’t been well understood is the best time a patient should receive this treatment – before or after surgery.

Esophageal cancer patients who received radiation treatment before surgery lived longer than patients who got radiation after surgery or not at all.

Researchers also evaluated if the timing of radiation was associated with heart complications that impacted survival. No such association was found.

"If you have difficulty swallowing, see your doctor."

Andrzej P.Wojcieszynski, MD, from the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues reviewed thousands of esophageal cancer patient records.

The study goal was to determine the optimal timing of radiotherapy in treating esophageal cancer - before or after surgery.

A total of 5,512 esophageal cancer patients were identified from 17 Surveillance, Epidemiology, and End Results (SEER) registries.

These individuals had been diagnosed with stage l or stage ll esophageal cancer and had undergone an esophagectomy (removal of the esophagus) between 1988 and 2007.

The patients had two types of esophageal cancer - adenocarcinoma or squamous cell carcinoma of the esophagus.

The study population included nearly 1,900 patients who had been given preoperative (before surgery) radiotherapy (RT), 900 who got postoperative RT and 2,730 who did not receive any RT.

Researchers found the following trends.

  • Among all the study members who were followed for 73 months, the median survival time was 28 months.
  • Those who received preoperative RT had a median survival of 27 months, compared to 20 months for those who received radiation after surgery (postoperative).
  • The five-year overall survival was 33 percent in the preoperative group versus 23 percent in the postoperative group.
  • 10-year survival was 22 versus 15 percent for preoperative and postoperative, respectively.
  • Cause-specific survival (CSS; death caused by specific condition) was also higher in the preoperative RT patients – with a CSS of 34 months versus 23 months for people who got post-surgical RT.
  • Cardiac complications did not affect survival in either RT group or patients who did not receive radiation.

The authors concluded that the study findings "support the use of preoperative RT as the standard of care for patients with locally advanced esophageal cancer and should not be withheld out of concern for cardiopulmonary mortality."

This study was published in the February issue of Cancer. No specific funding information was provided. The authors reported no conflicts of interest.

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Review Date: 
February 28, 2013
Last Updated:
March 1, 2013