A Comparison of Survival with Chemorradiation alone versus Surgery accompanied with Chemoradiation Therapy, in 266 Patients with non-Metastatic Esophageal Cancer in the State of Gilan (2004-2012)

Introduction & Due to esophageal cancer, over two thousand people lose their lives in Iran annually. Obviously, esophageal cancer can be curable, if an appropriate treatment is chosen. Although this disease is not one of the 10 common cancers in the world, esophageal cancer is very common in regions like the 5 northern provinces of Iran. In these areas its considered the biggest problem in the health care system, However, cancer behavior and response to the treatment is different in every geographical region. This study compares one to three-year survival rate of patients with esophageal cancer with chemoradiation therapy (CRT) alone versus surgery with chemoradiation therapy (CRT-S) during eight years in Gilan province. In this historical cohort study, all esophageal cancer patients’ records had been studied since the launching of radiotherapy clinic of Razi hospital in Rasht, during eight years (2004-2012). Finally, 266 patients in the stages II and III of esophageal cancer were entered in our study and were followed up till 2012. The patients were divided into two groups. The two groups treated by chemo-radiation therapy (CRT) alone and surgery plus chemo-radiation (S- CRT), were compared in terms of survival duration. The results were analysed by SPSS software using descriptive analytical statistic and statistical test Log Tarone-ware. In addition in order to stimate the rate of survival Kaplan-Meier and to estimate the chance of survival with the control of underline and interventive factors Cox Regression was used. Out of 266 patients in the stages II and III of esophageal cancer, 222 patients were treated by CRT (these patients were unwilling to undergo surgery) and 44 patients were treated by S-CRT. The mean age of the patients was 65 ±11. Most patients were men (57%). The most common site of tumor involvement was in the lower third of the esophagus (46%). The pathology of tumors was SCC in 80% of the cases. The mean age of overall survival was 17 ± 1.1 months with median survival of 12 months. The overall one year survival was 49% and the three year survival was 11.8%. The survival mean of patients with CRT was 17±1.2 months with median survival of 13 months and those with CRT-S was 18 ± 2.3 months with median survival of 14 months. There was no significant relationship in the rate of survival in two groups with the intervention, anatomic location, histologic type and gender were concerned. The rate of survival in SCC group and adenocarcinoma were compared and following results were obtained: survival of SCC patients, in both groups of CRT and CRT-S had no significant difference (P<0.32). Survival was higher in the adenocarcinoma group (P<0.0001). Patients with the non-metastatic esophagus cancer of SCC responded positively to chemo-radiation therapy alone, and adding surgery to patients’ treatment not only didn’t have any effect on the survival duration, but also caused big stress, high cost treatment for the patients and long hospitalization for health care system. Hence, chemo-radiation therapy alone is recommended for the treatment of non-metastatic esophagus cancer of SCC in high-risk areas.