Preoperative chemotherapy and radiation therapy for patients with cancer of the esophagus: a potentially curative approach.

Abstract

Twenty-one patients with squamous cell cancer of the esophagus were entered into a pilot clinical trial using preoperative chemotherapy (5-fluorouracil and cis-platinum) and radiation with the intent of improving cure rate and survival. After the preoperative treatment was complete, 15 patients (71%) were resected for cure. Seven (47%) of 15 had no histologic evidence of cancer in the resected esophagus, but two of these had microscopic cancer in resected lymph nodes. The median survival for all patients entered in the trial was 18 months, whereas for those with no cancer in the resected esophagus the median survival was 24 months. The six patients who either refused surgery (two patients) or were unresectable at surgery (four patients) died within nine months. Our conclusion in this trial is that survival and potential cure are clearly linked to successfully clearing the esophagus and nodes of histologic evidence of tumor through preoperative treatment.

Chemoradiotheraphy of Esophageal Cancer

“…The rst study reported from Wayne State University appeared promising, achieving a histologic complete response rate of 26% and a median survival of 18 months. Moreover, all complete responders were alive after two years (38). Similar results have been reported from other groups (39).…”

Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus

“…The value of chemoradiotherapy for the treatment of unresectable oesophageal carcinoma remains controversial, and only a few clinical studies have been published since the 1980s (Leichman et al, 1984;Leichman et al, 1987;Poplin et al, 1987;Coia et al, 1991;Herskovic et al, 1992;Frorastiere et al, 1993;Poplin et al, 1994). Most patients in these studies had local -regional disease (UICC stage I or II).…”

“…Several investigators have reported successful results with these modalities, either with or without surgery, against local -regional carcinoma (Leichman et al, 1984;Leichman et al, 1987;Poplin et al, 1987;Coia et al, 1991;Frorastiere et al, 1993;Poplin et al, 1994). The combination of 5-fluorouracil (5-FU) and cisplatin (CDDP) has become a standard regimen, not only because of the clinical outcome but also because of the synergism between the two agents and their radiosensitising effects (Douple et al, 1980;Scanlon et al, 1986;Byfield, 1990).…”

Multiple Management Modalities in Esophageal Cancer: Combined Modality Management Approaches

“…Of the 71% of patients who underwent curative resection, pathologic complete responses in the primary tumor site were detected in 47%, and a 27% operative mortality rate was observed. The median survival time for good responders was 24 months, and median survival time was 18 months for all patients enrolled in the study [62]. The Southwest Oncology Group (SWOG) 8037 trial, which evaluated 113 patients, used a similar regimen of concurrent 5-FU and cisplatin and 30 Gy of radiation before surgery.…”

“…Several nonrandomized trials from different institutions have reported good response rates from neoadjuvant chemoradiation [57][58][59][60][61][62][63][64][65][66][67][68][69][70]. Jones and colleagues from the University of North Carolina at Chapel Hill (Chapel Hill, NC) showed minimal toxicities from 45 Gy of radiation therapy combined with 5-FU and cisplatin chemotherapy given prior to surgery.…”