Esophageal carcinoma with doubtful extirpability. Value of preoperative chemotherapy plus radiotherapy.
To improve resectability for bulky esophageal tumors and/or tumors evolving close to the pharyngo-esophageal junction (PEJ), a combined preoperative chemotherapy plus radiotherapy (CT+RT) was given in 25 patients. There were 23 men and 2 women (mean age: 55 years); 21 had squamous cell carcinoma and 4 had adenocarcinoma. According to TNM classification based on computed tomography, the tumor was graded T3 in 20 cases, T4 in 2, T2 in 2 and T1 in 1. The preoperative treatment included two sessions of continuous infusion of 5-fluorouracil (800 mg/m2 per day) and cisplatin (20 mg/m2 per day), and combined radiotherapy (3 Gy/day). The overall tolerance was acceptable. The tumoral mass decreased in 23 patients (92%). All the patients underwent a wide esophagectomy; among the six patients with a tumor close to the PEJ, two required an associated pharyngolaryngectomy. The operative mortality rate was 8%. Major non-fatal complications occurred in 52%. On histology, there was no evidence of residual disease in seven patients (28%). The median survival was 18 months and the overall survival rate was 22.1% at 2 years. For the patients who had a complete histological response, the 2-year survival rate was 35%. Our data suggest that combined CT+RT may improve resectability of esophageal carcinoma. Improved survival rates seem to be appreciable in patients with a complete histologic response.
Sielezneff
I
I
Service de Chirurgie Thoracique et des Maladies de l'Oesophage, Hôpital Sainte-Marguerite, Marseille, France.
Thomas
P
P
Giovannini
M
M
Guidicelli
R
R
Seitz
J F
JF
Fuentes
P
P
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D015996:Survival Rate