Prospective randomised study on radiotherapy and surgery in the treatment of oesophageal carcinoma

Abstract

Between 1968 and 1981, a randomised prospective study was carried out on 156 patients with resectable and potentially curable middle third squamous cell carcinoma of the oesophagus. Four different management protocols were compared; surgery alone, pre-operative radiotherapy, postoperative radiotherapy and radiotherapy alone. Patients were given appropriate additional treatment for recurrent or metastatic disease. Operative mortality was significantly higher in the pre-operative radiotherapy group (30%) than in the other surgical groups (p < 0.001). The deaths were mainly due to postoperative chest infections. Of the patients initially treated with radiotherapy alone, more than one third required subsequent surgery within a year because of persistent dysphagia. In patients who failed radiotherapy treatment, the operative mortality was 54%. The radiotherapy alone group also had a significantly increased incidence of local recurrence compared with the other groups (76% vs 30% respectively, p < 0.001). Pre-operative radiotherapy had a lower incidence of metastases compared with the surgical groups, and postoperative radiotherapy had a lower incidence of local recurrence compared to surgery alone; neither, however, were statistically significant. There was no differences in the long term survival of the four groups but there were significant differences in the short and medium-term survivals. Patients treated with radiotherapy alone had the worst one- and two-year survival compared with the surgical groups (p < 0.05). Patients treated with pre-operative radiotherapy also had significantly lower six-month survival compared with the other surgical groups, chiefly because of the high operative mortality (p < 0.0025). Survival at 18 months for patients treated by postoperative radiotherapy was also worse than the surgery alone group (p < 0.05). It was concluded that surgery alone was the best primary treatment for resectable oesophageal cancer.