[Epidermoid cancer of the esophagus. Does the efficacy of chemoradiotherapy justify surgical abstention?].
Nine inoperable patients with squamous esophageal cancer were selected from 112 patients treated with combination chemo-radiotherapy. The criteria of selection were: 1) localized cancer (T1 or T2 of the TNM classification), 2) complete response after neoadjuvant chemotherapy suggesting the possibility of a good survival, 3) and 65 Gy-irradiation in the previous tumor bed. Eight of these 9 carcinomas recurred locally after a median delay of 12.6 months after the end of the treatment (extremes: 2 and 30 months). Only one patient is free of disease 24 months after the end of the treatment. These results point out that this chemo-radiotherapeutic association is disappointing in the long term in terms of loco-regional tumoral control and survival, but appeared to be good palliative treatment. This is an argument against the attitude of physicians who currently recommended a non-surgical strategy and deny the value of surgery. The carcinologic surgical excision of esophageal cancers is still the best treatment today. It must be performed whenever it is feasible, possibly associated with complementary treatments (evaluated in prospective studies).
Elias
D
D
Spielmann
M
M
Girinsky
T
T
Kac
J
J
Rougier
P H
PH
Lasser
P H
PH
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D013997:Time Factors
Cancers épidermoïdes de l'oesophage. L'efficacité des traitements chimio-radiothérapiques autorise-t-elle l'abstention chirurgicale?