Treating esophageal cancer with a combination of chemotherapy, radiation, and excision.
BACKGROUND
Treatment of esophageal cancer has been primarily palliative. Recent studies have shown that preoperative combination chemo- and radiation therapy increases the effectiveness of surgical excision.


METHODS
Beginning in 1990, 29 patients in the Spokane area were treated with preoperative chemo- and radiation therapy. They were 23 men and 6 women whose mean age was 66 years. Twenty-five had adenocarcinoma, of whom 3 had Barrett's esophagitis. Four had squamous cell carcinoma. The chemotherapy included fluorouracil, cisplatin, and vinblastine. Radiation was given concomitantly, BID for 21 days. Surgical excision was performed about 3 weeks after the last radiation session, pending recovery from cytopenia.


RESULTS
There was 1 operative death, for an operative mortality of 3.4%. Twenty-three patients (79%) were found to have no residual cancer at the time of resection. Of this group, 8 died of metastatic cancer at a mean of 15 months postoperatively (range 1 to 28), and 15 were alive at a mean of 28 months (range 12 to 46). Six patients (21%) had residual cancer in the resected specimen, either at the primary site or--more often--in adjacent lymph nodes. Five have died at 6, 8, 9, 24, and 28 months postoperatively; 1 remains alive at 14 months. The mean survival among these 6 patients is 15 months.


CONCLUSIONS
Combined chemo- and radiation therapy prior to esophagectomy appeared to improve outcome in this small series of patients with esophageal cancer. Local control was excellent, but distant metastasis continues to be a significant problem.
Girvin
G W
GW
Sacred Heart Medical Center, Spokane, Washington, USA.
Matsumoto
G H
GH
Bates
D M
DM
Garcia
J M
JM
Clyde
J C
JC
Lin
P H
PH
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D011829:Radiation Dosage; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D008130:Lomustine; D005472:Fluorouracil