[Clinico-pathological study of preoperative chemotherapy of esophageal cancer by combined use of three drugs--cisplatin, 5-FU and leucovorin].
We compared the clinical and pathological effects of preoperative combination chemotherapy using CDDP, 5-FU, and response rate for the primary lesion, an 81.8% response rate for intramural metastasis, 100.0% for intraepitherial spread, and a low response rate of 40.7% for lymph node metastasis. Pathological examination showed a 55.2% response rate for the primary lesion. There were seven cases in which the clinical assessment indicated that treatment was effective and pathological examination showed that it was ineffective, and three cases in which pathological examination showed a better response than clinical assessment. Cases showing a better clinical response included in which necrotic cancer lesion had disappeared due to absorption by the time of pathological examination, those with tumor regrowth after preoperative evaluation, those evaluated as showing a poor response due to residual cancer at the margin. Cases showing a better pathological response included those having remaining necrotic tissues and those having myoma beneath tumor. For intramural metastatic lesions, the pathological response rate was 42.9%, being lower than the clinical response rate. Metastasis to 209 lymph nodes showed a 23.0% response rate, with the abdominal nodes showing a poor response in comparison with those of the cervix and mediastinum. In 26 patients receiving preoperative radiotherapy, there was a significantly higher frequency of such changes as fibrous scar tissue, foreign body giant cells, vacuolation of tumor cells, and hyaloid degeneration of the lesion in comparison with the group receiving chemotherapy. Another difference was that the radiotherapy group showed a higher response of tumors with venous and lymphatic involvement.(ABSTRACT TRUNCATED AT 250 WORDS)
Yoshida
K
K
Department of Surgery, Tokyo Women's Medical College, Japan.
Ide
H
H
Hayashi
K
K
Nakamura
T
T
Eguchi
R
R
Hanyu
F
F
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care
D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil