title: Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer.
abstract: BACKGROUND
  We performed a multi-institutional randomized trial comparing preoperative chemotherapy followed by surgery with surgery alone for patients with local and operable esophageal cancer.
  
  
  METHODS
  Preoperative chemotherapy for patients randomly assigned to the chemotherapy group included three cycles of cisplatin and fluorouracil. Surgery was performed two to four weeks after the completion of the third cycle; patients also received two additional cycles of chemotherapy after the operation. Patients randomly assigned to the immediate-surgery group underwent the same surgical procedure. The main end point was overall survival.
  
  
  RESULTS
  Of the 440 eligible patients with adequate data , 213 were assigned to receive preoperative chemotherapy and 227 to undergo immediate surgery. After a median possible study time of 55.4 months, there were no significant differences between the two groups in median survival: 14.9 months for the patients who received preoperative chemotherapy and 16.1 months for those who underwent immediate surgery (P=0.53). At one year, the survival rate was 59 percent for those who received chemotherapy and 60 percent for those who had surgery alone; at two years, survival was 35 percent and 37 percent, respectively. The toxic effects of chemotherapy were tolerable, and the addition of chemotherapy did not appear to increase the morbidity or mortality associated with surgery. There were no differences in survival between patients with squamous-cell carcinoma and those with adenocarcinoma. Weight loss was a significant predictor of poor outcome (P=0.03). With the addition of chemotherapy, there was no change in the rate of recurrence at locoregional or distant sites.
  
  
  CONCLUSIONS
  Preoperative chemotherapy with a combination of cisplatin and fluorouracil did not improve overall survival among patients with epidermoid cancer or adenocarcinoma of the esophagus.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: D P
authors.initials: DP
authors.lastname: Kelsen
authors.forename: R
authors.initials: R
authors.lastname: Ginsberg
authors.forename: T F
authors.initials: TF
authors.lastname: Pajak
authors.forename: D G
authors.initials: DG
authors.lastname: Sheahan
authors.forename: L
authors.initials: L
authors.lastname: Gunderson
authors.forename: J
authors.initials: J
authors.lastname: Mortimer
authors.forename: N
authors.initials: N
authors.lastname: Estes
authors.forename: D G
authors.initials: DG
authors.lastname: Haller
authors.forename: J
authors.initials: J
authors.lastname: Ajani
authors.forename: W
authors.initials: W
authors.lastname: Kocha
authors.forename: B D
authors.initials: BD
authors.lastname: Minsky
authors.forename: J A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016019:Survival Analysis; D017211:Treatment Failure
chemical_list: D002945:Cisplatin; D005472:Fluorouracil