Preoperative chemotherapy for esophageal carcinoma with intramural metastasis.
OBJECTIVE
The prognosis for patients with intramural metastasis (IMM) of esophageal cancer is poor. We examined the role of preoperative chemotherapy in the management of patients with this disease.


METHODS
Fifteen patients with IMM of esophageal carcinoma received preoperative chemotherapy cisplatin on day 1 and 5-fluorouracil on days 1 to 5. This regimen was repeated after a 3-week interval, except in patients with progressive disease or severe toxicity who received only one cycle of chemotherapy. Patients underwent surgery around 3 weeks after completion of chemotherapy. Clinical response was evaluated and survival was compared with that of patients who did not receive preoperative chemotherapy.


RESULTS
Toxicity was manageable except in one patient who experienced severe neurological adverse effect. The clinical response rate of the IMM was 66.7% (10/15) and the complete response rate was 6.7% (1/15); for the primary lesion, response rates were 86. 7% and 6.7%, respectively. All 15 patients underwent surgery. Seven of the 15 patients (46.7%) experienced non-fatal operative complications. The 5-year survival rate after surgery was 20%.


CONCLUSIONS
Preoperative chemotherapy with cisplatin and 5-fluorouracil is feasible in patients with IMM of esophageal carcinoma. This regimen, however, does not improve survival and more effective treatment strategies are required.
Hokamura
N
N
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. hokamura@kmc.mhc.east.ntt.co.jp
Kato
H
H
Tachimori
Y
Y
Watanabe
H
H
Yamaguchi
H
H
Nakanishi
Y
Y
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D016019:Survival Analysis; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D002945:Cisplatin; D005472:Fluorouracil