Concurrent radiation therapy and chemotherapy followed by esophagectomy for localized esophageal carcinoma.
OBJECTIVE
A prospective study was performed to determine the outcome of patients with esophageal cancer who received preoperative radiation therapy and chemotherapy followed by esophagectomy, and to determine the role of preresection esophagogastroduodenoscopy (EGD) in predicting the patients in whom surgery could possibly be omitted, and the impact of surgery on survival.


METHODS
Thirty-five patients with localized carcinoma of the esophagus received concurrent external-beam radiotherapy and chemotherapy followed by esophagectomy. Patients received 45 Gy in 25 fractions. Chemotherapy consisted of continuous infusion fluorouracil (5-FU; 1,000 mg/m2/d) on days 1 through 4 and 29 through 32 and cisplatin (100 mg/m2) on day 1. Patients underwent an Ivor-Lewis esophagectomy 18 to 33 days after completion of radiotherapy.


RESULTS
Eighty percent of the patients had squamous cell carcinoma and 20% had adenocarcinoma. In addition, 51% had a pathologic complete response (CR). Twenty-two of the 35 underwent a preresection EGD before resection. Seventeen of the 22 (77%) had negative pathology from the preresection EGD, but seven of the 17 (41%) had residual tumor at surgery. The median survival and disease-free survival rates for all patients were 25.8 months and 32.8 months, respectively. Eighteen patients (51%) had no tumor at resection. The median survival for these patients was 36.8 months; the median disease-free survival time has not been reached. The median survival and disease-free survival rate for the patients with residual tumor in the surgical specimen were 12.9 months and 10.8 months, respectively.


CONCLUSIONS
Preresection EGD is not reliable for determining the presence of residual disease or the patients in whom surgery could be omitted. Twenty-five percent of the patients with residual tumor in the resected surgical specimen were long-term survivors; this suggests a benefit from esophagectomy after concurrent radiotherapy and chemotherapy.
Bates
B A
BA
Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill 27599-7512, USA.
Detterbeck
F C
FC
Bernard
S A
SA
Qaqish
B F
BF
Tepper
J E
JE
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000009:adverse effects; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D018365:Neoplasm, Residual / Q000473:pathology; D011878:Radiotherapy; D013530:Surgical Wound Infection / Q000209:etiology; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D002945:Cisplatin; D005472:Fluorouracil