Treatment results of radical surgery and definitive chemoradiotherapy for patients with submucosal esophageal squamous cell cancinomas

Background: A radical esophagectomy with extensive lymph node dissection is the mainstay treatment for submucosal esophageal cancer, though definitive chemoradiotherapy (CRT) has also been applied. However, the treatment outcomes have not yet been extensively investigated. Patients and Methods: Forty-nine patients with submucocal esophageal squamous cell carcinoma, 24 and 25 of whom had been treated by a radical esophagectomy with extensive lymph node dissection (Surgery group) and definitive CRT using 5-Fluorouracil and CDDP with concurrent radiation of 60 Gy (CRT group), respectively, formed the study cohort. Results: In the Surgery group, the overall and cause-specific 5-year survival rates were 75.4% and 90.0%, respectively. No operative or hospital deaths had occurred. In the CRT group, a complete response (CR) had been achieved in 22 (88%) patients. The 3- and 5-year overall survival rates were 79.3% and 36.9%, respectively, while the cause-specific 3- and 5-year survival rates were 75.2% and 55.7%, respectively. No treatment-related deaths had occurred. Conclusion: These data suggest that: (i) a radical esophagectomy with extensive lymph node dissection can be a standard treatment offering excellent survival and (ii) a definitive CRT is a reasonable alternative to surgery, especially for patients with complications.