Prospective evaluation of preoperative chemotherapy in resectable squamous cell carcinoma of the thoracic esophagus

Abstract

A prospective study was performed to clarify the surgical outcome of patients with esophageal carcinoma who would benefit from induction chemotherapy followed by surgery. Of 55 eligible patients, 42 (76.3%) agreed to randomization with either chemotherapy followed by surgery (n = 21) or surgery alone (n = 21). The other 13 refused. The chemotherapy consisted of cisplatin, 5-fluorouracil and leucovorin. All 55 patients underwent esophagectomy with two- or three-field resection, including two (3.6%) hospital mortalities. Of the 21 patients receiving chemotherapy, the response rate was 33.3% after the first course and 60% after the second course. A complete response was not obtained. Responders to the first course showed a prolonged survival, however time to treatment failure did not differ between patients treated with chemotherapy followed by surgery or surgery alone. This chemotherapy offered a worse surgical outcome for patients with pretreatment diagnosis of T3. Multivariate analysis identified a partial response to the first course of chemotherapy to be a favorable prognostic indicator. Preoperative chemotherapy does not give a survival benefit over surgery alone for patients with advanced tumor (T3). Initial response to the first dose of chemotherapy is deemed to be a prognostic factor for patients with less advanced tumor (T1/T2).

Neoadjuvant Chemotherapy for Resectable Esophageal Carcinoma: A Meta-analysis of Randomized Clinical Trials

“…Only sixteen studies (Roth et al, 1988;Nygaard et al, 1992;Schlag, 1992;Liao et al, 1993;Maipang et al, 1994;Law et al, 1997;Kelsen et al, 1998;Baba et al, 2000;Ancona et al, 2001;Cao et al, 2001;Wang et al, 2001;Medical Research Council Oesophageal Cancer Working Group, 2002;Cunningham et al, 2006;Ma et al, 2007;Peng et al, 2007;Bokhyan et al, 2009) were in accordance with the above-mentioned inclusion criteria (Figure 1). Eleven was published in English and five in Chinese.…”

“…In the neoadjuvant chemotherapy group, surgery will be done early after one week, lately six weeks, chemotherapy regimen including 2-4 cycles. The tumor stage of the most patients in the sixteen studies ranged from II-Ⅲ, but more advanced tumor stage (Ⅳa) was also seen in three RCTs (Law et al, 1997;Baba et al, 2000;Cunningham et al, 2006), total 82 patients. Finally, tumor stage was not reported in two RCTs (Roth et al, 1988;Bokhyan et al, 2009).…”

“…A total of sixteen articles were evaluated as RCTs. Only six trials (Kelsen et al, 1998;Roth et al, 1988;Baba et al, 2000;Ancona et al, 2001;Medical Research Council Oesophageal Cancer Working Group, 2002;Cunningham et al, 2006) described details of the methods used, and eight trials (Roth et al, 1988;Schlag, 1992;Law et al, 1997;Kelsen et al, 1998;Baba et al, 2000;Ancona et al, 2001;Medical Research Council Oesophageal Cancer Working Group, 2002;Cunningham et al, 2006) provided information of allocation concealment. Five studies reported information of blinding between practitioners and participants, or blinding of outcome assessors.…”

“…The literatures were published between 1988 and 2009. Of these sixteen studies, seven (Nygaard et al, 1992;Schlag, 1992;Maipang et al, 1994;Law et al, 1997;Baba et al, 2000;Ancona et al, 2001;Ma et al, 2007) were restricted to patients with esophageal squamous cell carcinoma only, one (Cunningham et al, 2006) was restricted to patients with esophageal adenocarcinoma only, and the remaining eight trials enrolled patients with SCC and AC. Nearly all the patients in the surgery alone group underwent surgery, yet there were more patients in the chemotherapy group who had not completed the planned chemotherapy regimen for various causes such as side effects of chemotherapy or metastasis of cancer before surgery.…”

“…As a result, we can accurately differentiate tumor stages from esophageal cancer patients before surgical resection. The 82 patients in RCTs (Law et al, 1997;Baba et al, 2000;Cunningham et al, 2006) included in this meta-analysis had metastasis of forane lymph nodes, and they belong to Ⅳ according to TNM staging. Using neoadjuvant chemotherapy before radical resection of esophageal cancer could also improve survival in these patients with esophageal cancer.…”