Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: Analysis of surveillance, epidemiology, and end results-Medicare data.

To determine the value of radiotherapy in addition to esophagectomy for stage II and III TESCC. We searched the Surveillance, Epidemiology, and End Results (SEER) database for all cases of stage II-III TESCC. Patients were grouped as those receiving pre- or postoperative radiotherapy plus esophagectomy and those receiving esophagectomy alone. Overall survival (OS) and cancer-specific survival (CSS) were compared between the groups. Among the 3292 patients, multimodality treatments (pre- or postoperative radiotherapy plus surgery) were more effective than surgery alone (5-year, OS: 17.3% vs 7.9%; P < 0.001; CSS: 51.8% vs 34.9%; P < 0.001). Among the patients receiving multimodality treatments, multivariate analyses revealed stage to be the most significant prognostic factor for OS (II vs III, HR, 0.726; P < 0.001), but the sequence of radiotherapy and surgery was only of the marginal significance (pre- vs postoperative, HR, 0.875; P = 0.093). Preoperative radiotherapy provided significantly better survival than postoperative radiotherapy in stage III disease (5-year, OS: 13.0% vs 11.0%, P < 0.04; CSS: 49.2% vs 31.7%, P < 0.003), but not in stage II disease (5-year OS: 23.5% vs 21.0%, P = 0.519; CSS: 62.0% vs 53.4%, P = 0.075). Radiotherapy in addition to esophagectomy provides better outcomes than esophagectomy alone for in stage II-III TESCC. Preoperative radiotherapy followed by surgery appears to be the optimal treatment strategy in stage III TESCC.