ABSTRACT
Introduction: Data on combined modality treatment for locally advanced squamous cell carcinoma of the oesophagus involving Asian patients are limited. Materials and Methods: A retrospective study of 56 consecutive patients with this condition treated with concurrent chemoradiotherapy followed by surgery in a single tertiary institution in Singapore was performed. Results: The median overall survival of the entire cohort was 14.1 months [95% confidence interval (CI); range, 8.6 to 19.6 months]. In patients who underwent successful oesophagectomy after chemoradiotherapy (n = 17), the median survival was 27.8 months compared to 9.8 months for those who did not have surgery (n = 39) (P = 0.046, log-rank test). The median time to first relapse for the entire cohort was 16.1 months (95% CI, 7.7 to 24.5 months). The time to first relapse was 23.9 months in the subgroup of patients with successful surgery and 12.1 months in the group which did not (P = 0.147, log-rank test). The high proportion of patients who were medically unfit for surgery or declined surgery may have conferred a selection bias. Conclusion: Concurrent chemoradiotherapy followed by surgery is feasible in selected patients. The benefit of adding of surgery to chemoradiotherapy is still controversial and we await the results of randomised controlled trials comparing chemoradiotherapy with surgery versus chemoradiotherapy alone.
Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases were diagnosed from 1993 to 1997. The age-standardised rate for the same period was 5.8 per 100,000.1 The predominant histologic type is squamous cell carcinoma, although there has been a shift towards adenocarcinoma histology in recent years in Western populations. The majority of patients present late in the course of disease, as a result of which long-term survival is poor. While concurrent chemoradiotherapy has been defined as the standard of care in unresectable non-metastatic disease,2 controversy still exists in the setting of locally advanced but surgically resectable carcinoma of the oesophagus.
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