KEY POINTS
- This single-centre retrospective study reviewed 1,090 patients undergoing oesophagectomy between 2009 and 2020 and included 356 with R0-resected pT3N0M0 thoracic oesophageal squamous cell carcinoma who received adjuvant treatment.
- Postoperative chemotherapy alone was given to 274 patients, while 82 received postoperative chemoradiotherapy. Propensity-score matching produced two groups of 82 patients with balanced measured clinicopathological characteristics.
- Chemotherapy was predominantly cisplatin-based, with a median of three cycles. Postoperative radiotherapy delivered 45–60 Gy in 25–30 fractions to the tumour bed and high-risk lymphatic regions.
- In the matched cohort, five-year overall survival was 65.3% with chemotherapy versus 71.4% with chemoradiotherapy (p = 0.90), while five-year disease-free survival was 63.3% versus 70.9% (p = 0.77).
- The treatment strategy was not independently associated with overall survival after matching (hazard ratio 0.90; 95% confidence interval, 0.50–1.65; p = 0.70).
- Locoregional recurrence occurred in 15 versus 8 patients after chemotherapy and chemoradiotherapy, respectively (p = 0.30). Distant metastases occurred in 13 versus 11 patients (p = 0.90).
- An exploratory subgroup analysis associated chemoradiotherapy with better disease-free survival in lower-third tumours (hazard ratio 0.09; 95% confidence interval, 0.01–0.68; p = 0.020), but no subgroup showed a statistically significant overall-survival benefit. Treatment-related toxicity was not reported.
CLINICAL TAKEAWAY
Routine postoperative radiotherapy cannot be justified from these data for all patients with R0-resected pT3N0M0 disease already receiving chemotherapy. A possible reduction in locoregional recurrence and the lower-third tumour signal warrant prospective study, but residual confounding, limited subgroup size and absent toxicity data prevent a reliable benefit-risk assessment.