Primary Radiotherapy Compared With Primary Surgery in Cervical Esophageal Cancer

IMPORTANCE The management of cervical esophageal cancer (CEC) is controversial. The advantages of radiotherapy (RT) for CEC are lower rates of acute morbidity and mortality compared with surgery and potential for larynx preservation. The advantage of surgery is that the transposed stomach may function better over the long term than an irradiated esophagus, which tends to become stenotic over time. Which one is the primary treatment of CEC? OBJECTIVE To evaluate treatment outcomes of primary RT and primary surgery in patients with CEC. DESIGN, SETTING, AND PARTICIPANTS This retrospective study conducted in a university hospital included 224 patients treated for CEC between 2001 and 2012. INTERVENTIONS One hundred and sixty-one patients who received primary RT with or without subsequent surgery were assigned to the RT group, including 133 patients who received RT alone or RT with concurrent chemotherapy and 28 patients who received preoperative RT plus surgery. Sixty-three patients who received primary surgery with or without subsequent RT were assigned to the primary surgery group, including 27 patients who received surgery alone and 36 patients who received surgery plus postoperative RT. MAIN OUTCOMES AND MEASURES The rates of overall 2-year local failure-free survival (FFS), regional FFS, distant FFS, and overall survival for patients undergoing primary RT and primary surgery were compared. A separate analysis using matched cases between the primary RT group and primary surgery group was conducted. RESULTS The median follow-up time was 15.1 months. The rates of overall 2-year local FFS, regional FFS, distant FFS, and overall survival for patients undergoing primary RT and primary surgery were 69.9% and 68.6%, 79.5% and 69.8%, 74.3% and 62.5%, 49.3% and 50.7%, respectively (P > .05 for all). Matched-case analyses did not show any significant differences in measured survival rates between the treatment groups. CONCLUSIONS AND RELEVANCE Given the similarities in rates of local FFS, regional FFS, distant FFS, and overall survival between the primary RT and primary surgery CEC treatment groups, we recommend primary RT for larynx preservation, with surgery offered subsequently for patients who do not respond to RT.