title: Improved survival with neoadjuvant therapy and resection for adenocarcinoma of the esophagus.
abstract: OBJECTIVE
  This study sought to determine the impact of preoperative chemotherapy and radiation therapy (neoadjuvant therapy) followed by resection in patients with adenocarcinoma of the esophagus.
  
  
  BACKGROUND
  Long-term survival in patients with carcinoma of the esophagus has been poor. An increase in the incidence of adenocarcinoma of the esophagus has been reported recently.
  
  
  METHODS
  Fifty-eight patients with biopsy-proven adenocarcinoma of the esophagus treated at this institution from January 1951 through February 1993 were studied. Since 1989, 24 patients were entered prospectively into a multimodality treatment protocol consisting of preoperative cisplatin, 5-fluorouracil (5-FU), and leucovorin with or without etoposide, and concomitant mediastinal radiation (30 Gy). Patients were re-evaluated and offered resection.
  
  
  RESULTS
  There were no deaths related to neoadjuvant therapy and toxicity was minimal. Before multimodality therapy was used, the operative mortality rate was 19% (3 of 16 patients). With multimodality therapy, there have been no operative deaths (0 of 23 patients). The median survival time in patients treated before multimodality therapy was 8 months and has yet to be reached for those treated with the neoadjuvant regimen (> 26 months, p < 0.0001). The actuarial survival rate at 24 months was 15% before multimodality therapy and 76% with multimodality therapy. No difference in survival was noted in neoadjuvant protocols with or without etoposide (p = 0.827).
  
  
  CONCLUSIONS
  Multimodality therapy with preoperative chemotherapy and radiation therapy followed by resection appears to offer a survival advantage to patients with adenocarcinoma of the esophagus.
authors.affiliation: Department of Cardiac and Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: J R
authors.initials: JR
authors.lastname: Stewart
authors.forename: S J
authors.initials: SJ
authors.lastname: Hoff
authors.forename: D H
authors.initials: DH
authors.lastname: Johnson
authors.forename: M J
authors.initials: MJ
authors.lastname: Murray
authors.forename: D R
authors.initials: DR
authors.lastname: Butler
authors.forename: C C
authors.initials: CC
authors.lastname: Elkins
authors.forename: K W
authors.initials: KW
authors.lastname: Sharp
authors.forename: W H
authors.initials: WH
authors.lastname: Merrill
authors.forename: J L
authors.initials: JL
authors.lastname: Sawyers
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D015996:Survival Rate