Primary Radiation vs. Primary Surgical Therapy for Cervical Esophageal Cancer

What is the best initial therapy for patients requiring treatment of cervical esophageal cancer?

Background: Cancer of the cervical esophagus is infrequently encountered by the otolaryngologist; however, head and neck surgeons may be asked to collaborate with the treatment team providing care for these patients. Treatment has largely been surgical resection, radiation therapy, chemoradiation therapy, or a combination of the three. Surgical resection requires laryngectomy under most circumstances. The advantage of surgery is that after surgery, the stomach functions better over the long term than does the irradiated esophagus. Unfortunately, level one evidence is not available.

Study design: Retrospective study.

Setting: The Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing.

Synopsis: During a 12-year period, 161 patients were encountered with cervical esophageal cancer. In this group, 133 received irradiation therapy alone, concurrent with chemotherapy, while 28 patients received radiation therapy (RT) followed by surgery. A separate group of 63 patients had surgery, sometimes followed by radiation therapy. This included 27 patients who received surgery alone and 36 patients who received surgery plus RT. Follow-up demonstrated similar rates of failure-free survival, including analysis of regional, distant, and overall survival.

Bottom line: In the absence of level one data, radiation therapy should be considered as primary intervention for patients with cancer of the cervical esophagus.

Citation: Cao CN, Luo JW, Gao L, et al. Primary radiotherapy compared with primary surgery in cervical esophageal cancer. JAMA Otolaryngol Head Neck Surg. 2014;140:918-926.