The need for surgery after chemoradiotherapy for a T4N0-1M0 squamous cell carcinoma in the thoracic esophagus was evaluated. A series of 53 patients were enrolled in this prospective nonrandomized trial from among 124 patients with an esophageal cancer assessed as T4 in Kurume University Hospital from 1994 to 2002. After the first chemoradiotherapy cycle, which consisted of radiotherapy in a total dosage of 36 Gy and chemotherapy using cisplatin (CDDP) and 5-fluorouracil (5FU), the patients each decided, after being informed of the efficacy of the chemoradiotherapy, whether to undergo surgery. All patients, including those who had undergone surgery and those who had not, later underwent a second chemoradiotherapy cycle consisting of radiotherapy in a total dosage of 24 Gy and chemotherapy using CDDP and 5FU, as far as practicable. Among the responders to the first chemoradiotherapy cycle, there was no significant difference in the long-term (5-year) survival rate between the 18 patients who underwent esophageal surgery and the 13 patients who did not (23% vs. 23%). Among the nonresponders, the 11 patients who underwent surgery showed a tendency toward longer survival than the five patients who had had no surgery. The nonresponders had 1- and 2-year survival rates of 64% and 33%, respectively. The corresponding rates for the 5 nonsurgical patients who completed the two chemoradiotherapy cycle were 20% and 20%, respectively. For a T4N0-1M0 squamous cell carcinoma in the thoracic esophagus, full-dosage chemoradiotherapy (definitive chemoradiotherapy) is preferred for responders to a half-dose of chemoradiotherapy as much as esophagectomy, whereas esophagectomy may be preferred for nonresponders.

ObjectiveThe objective of this study was to determine whether oral glutamine supplements can protect lymphocyte and gut barrier function in patients with advanced esophageal cancer undergoing radiochemotherapy. Summary Background DataGlutamine supplements improved protein metabolism in tumor bearing rats who underwent chemotherapy and reduced the toxicity of chemotherapy through an enhancement of glutathione production in rats. MethodsThirteen patients with esophageal cancer were randomly placed in either a control or a glutamine group. Glutamine was administered orally (30 g/day) at the start of radiochemotherapy and for the subsequent 28 days. All patients underwent mediastinal irradiation and chemotherapy consisting of 5-fluorouracil and cisplatin. The lymphocyte count was determined, and blast formation was assessed after stimulation with phytohemagglutinin and concanavalin A. Gut barrier function was assessed by measuring the total amount of phenolsulfonphthalein excreted in the urine after the oral administration of phenolsulfonphthalein. ResultsGlutamine supplements prevented a reduction in the lymphocyte count (control: 567 ± 96/mm3 vs. glutamine: 1007 + 151, p < 0.05), and blast formation of lymphocyte (phytohemagglutinin, control: 19478 ± 2121

No abstract