[Improvement of treatment of carcinoma of the thoracic esophagus, especially in reference to the transition in postoperative combined therapy].
It has become clear that postoperative combined therapy performed in our department has improved the prognosis of patients with carcinoma of the thoracic esophagus and changed the pattern of recurrence. In cases of postoperative radioimmunochemotherapy (a combination of 4000 rad of irradiation, with administration of 5-Fu and bleomycin, and the prescription of OK-432 and/or PSK after irradiation) was effective in preventing recurrence. In cases of n1(+) and n2(+), such therapy was effective in controlling local recurrence such as cervical and thoracic nodes. However, the 5-year survival rate of this group was 44.3%, indicating a need for more effective postoperative therapy. Thus, new radiochemoimmunotherapy (irradiation 4000R, 15-30mg/m2 x 2 CDDP, 2mg/body x 2 VDS) combined with three kinds of cytokines such as tumor necrosis factor (TNF), interleukin-II (IL-II) and interferon (IFN)-alpha has been applied in cases of n1(+), n2(+). Postoperative aggressive chemotherapies (old protocol, PAM treatment with a combination of Pepleomycin, Adriamycin and Mitomycin: Or new protocol, F.CAV treatment with a combination of 5-Fu, CDDP, Adriamycin and Vindesine) were effective in improving the prognosis of patients with n3(+) and n4(+). The 5-year survival rate improved from 2.7% with other therapies to 20. 5% with this therapy.
Nishihira
T
T
Second Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
Hirayama
K
K
Shineha
R
R
Sanekata
K
K
Shiga
K
K
Takano
R
R
Mori
S
S
D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011184:Postoperative Period; D011379:Prognosis; D013903:Thoracic Surgery