Original communication| Volume 113, ISSUE 2, P138-147, February 1993

Postoperative radiotherapy for carcinoma of the esophagus: A prospective, randomized controlled study

      This paper is only available as a PDF. To read, Please Download here.


      Methods. A prospective, randomized controlled study of radiotherapy after resection of esophageal carcinoma was carried out in 130 patients. Patients were stratified according to whether the resection was curative or palliative and were then randomized to receive postoperative radiotherapy or no additional treatment. Sixty patients underwent curative resection; 30 each were randomized into the radiotherapy group (CR + R) and the control group (CR). Seventy patients underwent palliative resection; 35 each were randomized into the radiotherapy group (PR + R) and the control group (PR).
      Results. No complications occurred while the patients were undergoing radiotherapy treatment. On follow-up, complications in the intrathoracic stomach occurred in 24 patients (37%) who underwent radiotherapy compared with four patients (6%) in the control group (p < 0.0001). Seventeen of these 24 patients in the radiotherapy group had gastric ulceration and there were five deaths as a result of bleeding. Local recurrence developed significantly less frequently in the PR + R group compared with the PR group (seven patients [20%] vs 16 patients [46%]; p = 0.04); no difference was observed between CR + R and CR groups (10% and 13%, respectively). Intrathoracic recurrence occurred in fewer patients in the radiotherapy groups (CR + R and PR + R) compared with the control groups (CR and PR) (four patients vs 15 patients; p = 0.01). In patients with residual tumor in the mediastinum after resection, two (7%) of 29 patients who underwent radiotherapy died of tracheobronchial obstruction, compared with nine (33%) of 27 patients in the control groups (p = 0.03). No difference in local recurrence was observed for extrathoracic or anastomotic recurrence. Distant metastasis developed in 12 patients (40%) in the CR + R group, nine patients (30%) in the CR group (p = 0.59), 24 patients (69%) in the PR + R group, and 18 patients (51%) in the PR group (p = 0.22). The time of onset of metastasis was 5.1 months for the PR + R group, which was shorter than the 8.5 months for the PR group (p = 0.05). The time of onset of metastasis was similar for the CR + R and CR groups (9.9 months and 11.0 months, respectively; p = 0.76). The overall median survival of patients after postoperative radiotherapy (CR + R and PR + R) was 8.7 months, which was shorter than the 15.2 months for the control groups (CR and PR) (p = 0.02).
      Conclusions. The shorter survival of patients who underwent postoperative radiotherapy was the result of irradiation-related death and the early appearance of metastatic diseases. The role of postoperative radiotherapy is therefore limited to a specific group of patients with residual tumor in the mediastinum after operation, for whom radiotherapy can significantly reduce the incidence of local recurrence obstructing the tracheobronchial tree.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Orton CG
        • Ellis F
        A simplification in the use of the NSD concept in practical radiotherapy.
        Br J Radiol. 1973; 46: 529-537
        • Earlam R
        • Cunha-Melo JR
        Oesophageal squamous cell carcinoma: II. A critical review of radiotherapy.
        Br J Surg. 1980; 67: 457-461
        • Kelsen D
        Neoadjuvant therapy of esophageal cancer.
        Can J Surg. 1989; 32: 410-414
        • Herskovic A
        • Leichman L
        • Lattin P
        • et al.
        Chemo-radiation with and without surgery in the thoracic esophagus: the Wayne State experience.
        Int J Radiat Oncol Biol Phys. 1988; 15: 655-662
        • Poplin E
        • Fleming T
        • Leichman L
        • et al.
        Combined therapies for squamous-cell carcinoma of the esophagus, a Southwest Oncology Group study (SWOG-8037).
        J Clin Oncol. 1987; 5: 622-628
        • Orringer MB
        • Forastiere AA
        • Perez-Tamayo C
        • Urba S
        • Takasugi BJ
        • Bromberg J
        Chemotherapy and radiation therapy before transhiatal esophagectomy for esophageal carcinoma.
        Ann Thorac Surg. 1990; 49: 348-354
        • Kelsen DP
        • Ahuja R
        • Hopfan S
        • et al.
        Combined modality therapy of esophageal carcinoma.
        Cancer. 1981; 48: 31-37
        • Parker EF
        • Marks Jr, RD
        • Kratz JM
        • Chaikhouni A
        • Warren ET
        • Bartles DM
        Chemoradiation therapy and resection for carcinoma of the esophagus: short term results.
        Ann Thorac Surg. 1985; 40: 121-125
        • Popp MB
        • Hawley D
        • Reising J
        • et al.
        Improved survival in squamous esophageal cancer.
        Arch Surg. 1986; 121: 1330-1335
        • Gignoux M
        • Roussel A
        • Paillot B
        • et al.
        The value of preoperative radiotherapy in esophageal cancer: results of a study of the E.O.R.T.C.
        World J Surg. 1987; 11: 426-432
        • Launois B
        • Delarue D
        • Campion JP
        • Kerbaol M
        Preoperative radiotherapy for carcinoma of the esophagus.
        Surg Gynecol Obstet. 1981; 153: 690-692
        • Huang GJ
        • Gu XZ
        • Wang LJ
        • et al.
        Experience with combined preoperative irradiation and surgery for carcinoma of esophagus.
        Gan Monogr Cancer Res. 1986; 31: 159-164
        • Akakura I
        • Nakamura Y
        • Kakegawa T
        • Nakayama R
        • Watanabe H
        • Yamashita H
        Surgery of carcinoma of the esophagus with preoperative radiation.
        Chest. 1970; 57: 47-57
        • Kasai M
        • Mori S
        • Watanabe T
        Follow-up results after resection of thoracic esophageal carcinoma.
        World J Surg. 1978; 2: 543-551
        • Sunagawa M
        • Endo M
        Clinical evaluation of adjuvant radiotherapy and chemotherapy for esophageal carcinoma.
        Gan To Kagaku Ryoho. 1988; 15: 1634-1639
        • Nishiyama K
        • Kagami Y
        • Ikeda H
        • Masaki N
        • Shigematsu Y
        • Okagawa K
        Radiation therapy of esophageal cancer: radical radiotherapy and radiotherapy in combination with surgery.
        Gan To Kagaku Ryoho. 1982; 9: 2077-2083
        • Tanaka Y
        • Fujita K
        • Miyama T
        • Sakura M
        • Takubo K
        • Mafune K
        An evaluation of postoperative prophylactic irradiation for esophageal cancer.
        in: Siewert JR Holscher AH Diseases of the esophagus. Springer-Verlag, Berlin1988: 342-348
        • Sun DR
        Ten-year follow-up of esophageal cancer treated by radical radiation therapy: analysis of 869 patients.
        Int J Radiat Oncol Biol Phys. 1989; 16: 329-334
        • Langer M
        • Choi NC
        • Orlow E
        • Grillo H
        • Wilkins Jr, EW
        Radiation therapy alone or in combination with surgery in the treatment of carcinoma of the esophagus.
        Cancer. 1986; 58: 1208-1213
        • Yokoyama Y
        • Sakamoto K
        • Arai M
        • Akagi M
        Radiation and surgical stress induce a significant impairment in cellular immunity in patients with esophageal cancer.
        Jpn J Surg. 1989; 19: 535-543
        • Maeta M
        • Koga S
        • Andachi H
        • Ishiguro M
        Preoperative radiotherapy and intra-abdominal metastasis of the lymph node in the surgical treatment of carcinoma of the thoracic esophagus.
        Surg Gynecol Obstet. 1987; 165: 235-238