Cancer of the distal esophagus and cardia: preoperative irradiation prolongs survival.

Ninety-five patients with carcinoma of the esophagus and gastric cardia seen between 1979 and 1984 were managed in one of four ways: radiotherapy alone (6,000 rads), esophagogastrectomy alone, preoperative radiotherapy (4,000 rads over 4 weeks) followed by esophagogastrectomy, or no definitive treatment for patients with advanced disease. Patients who receive radiotherapy alone or no definitive therapy were considered unfit for operation; however, those patients who had operation only were equivalent with regard to histologic stage and risk to patients who received preoperative radiotherapy and surgery. Patients who received no definitive therapy died within 1 year, with a mean survival of 3.7 months. The mean survival for patients who received radiotherapy only was 8.3 months; for those who had surgery alone, 13 months; and for those who had preoperative radiotherapy, 24 months. Patients who received preoperative radiotherapy had significantly longer survival times when followed 12, 15, and 18 months postoperatively. Preoperative radiotherapy did not improve overall resectability, and postoperative mortality was similar in the two surgical groups. In comparable patients treated by esophagogastrectomy, preoperative irradiation prolonged the disease-free survival time and is advocated for all surgical candidates.