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Sachiko Yamamoto MD, Ryu Ishihara MD, Masaaki Motoor i MD, Yoshifumi Kawaguchi MD, Noriya Uedo MD, Yoji Tak euchi MD, Koji Higashino MD, Masahiko Yano MD, Satoak i Nakamura MD and Hiroyasu Iishi MD Am J Gastroenterol 2011; 106:1048–1054 R1 Jong Kyu Byun/ Prof. Jae Young Jang Esophageal cancer is the sixth most common causes of cancerrelated mortality worldwide. Squamous cell carcinoma remains the most common tumor type. Stage I (UICC-TNM classification: T1N0M0) esophageal cancer, defined as mucosal or submucosal cancer without lymph node or d istant metastasis Esophagectomy has been the mainstay of treatment for esophageal cancer Esophagectomy is associated with significant mortality and substan tial morbidity. Chemoradiotherapy (CRT) has been proposed as an alternative to esophagectomy, because of its favorable survival rate and mild toxicity To compare the overall survival of two cohorts of patients with clinical stage I esophageal squamous cell carcinoma treated with either CRT or conventional esophagectomy. Patient population and staging system Retrospective cohort study of patients with clinical stage I esophageal squamous cell carcinoma, untreatable by endoscopic therapy. Submucosal cancers or widespread cancers larger than 5 cm or with a circumferential spread more than 2/3 were referred for CRT or esophagectomy Diagnostic tool T-category - endoscopy, N-category - CT. endosonography Chemoradiotherapy A total of 53 patients were treated with cisplatin and fluorouracil- based chemotherapy Concurrent radiotherapy using 10-MV X-rays was delivered at a dose of 2 Gy per day, five days a week, for a total dose of 60 Gy in 30 fractions. Esophagectomy Two- or three-field lymphadenectomy via rightthoracotomy Follow-up evaluation and pattern of recurrence CRT 1–2 months after CRT and then every 3–6 months for the first 2 years, and every 6 months thereafter. PEx , blood test, endoscopy of the esophagus with iodine staining, and CT scan of the neck, chest, and abdomen. Esophagectomy every 6 months for 5 years. PEx, blood test, and CT scan of the neck, chest, and abdomen. Endoscopy was performed annually. Local recurrence included the recurrence or progression of the primary tumor, and metachronous esophageal cancer. Non-local recurrence included recurrence in the lymph nodes or any site beyond the primary tumor. Statistical analysis overall survival, Start : Day 1 of CRT or the date of esophagectomy End : The date of death or 31 March 2009, whichever occurred first. progression-free survival (PFS) Start : Day 1 of CRT or the date of esophagectomy, End : The date of recurrence or death, or 31 March 2009, whichever occurred first. For all analyses a two-sided P value of <0.05 was considered statistically significant. SURG group CRT group Survival Follow up CRT group 100 % (54 patients) SURG group 99 % (115 of 116 patients ) Observation period CRT group SURG group 30 (4–77) months 67 (10–171) months Death CRT group SURG group 6 (3 deaths due to esophageal ca.) 30 (20 deaths due to esophageal ca.) Overall survival rates SURG CRT 1- year 97.4% 98.1% 3-year 85.5% 88.7% PFS (non-local) rates SURG CRT 1- year 93.9% 90.5% 3-year 81.9% 83.5% The overall survival rate Locally recurrent carcinoma was endoscopically treatable in most patients, with no effect on overall survival. CRT seems to be a viable alternative to esophagectomy in patients with clinical stage I esophageal cancer.