The possible organ-preservation strategy of definitive chemoradiotherapy as a primary treatment for esophageal cancer was evaluated in randomized controlled studies. For a study, the researchers sought to find how long people lived after receiving definitive chemoradiotherapy (DCR) with or without salvage esophagectomy (SALV) for esophageal cancer. Patients with nonmetastatic esophageal cancer who received either DCR (n=5977) or neoadjuvant chemoradiotherapy with planned esophagectomy (NCRS) (n=13,555) were identified using data from the National Cancer Database (NCDB) from 2004 to 2015. Treatment selection bias was accounted for using propensity score matching and multivariable analysis. Patients who received SALV following DCR were compared to those who received NCRS in subset analyses. Patients undergoing NCRS were younger, had fewer medical comorbidities, had a lower frequency of squamous cell carcinoma (SCC), and had more positive lymph nodes, according to baseline demographics of the unmatched group. Following matching, NCRS was found to have a significantly better survival rate than DCR [hazard ratio (HR): 0.60, 95% CI: 0.57–0.63, P<0.001], which was confirmed in subset analyses of patients with adenocarcinoma (HR: 0.60, 95% CI: 0.56–0.63, P<0.001) and SCC (HR: 0.58, 95% CI: 0.53–0.63, P<0.001). About 823 patients were matched to 1643 NCRS after receiving SALV following DCR. Overall survival did not differ between SALV and NCRS (HR: 1.00, 95% CI: 0.90–1.11, P=1.0). Surgery was still an essential part of the treatment of esophageal cancer patients. In individuals with locoregional esophageal cancer, neoadjuvant therapy followed by planned esophagectomy appears to be the best curative therapeutic option.
