[Neoadjuvant chemoradiotherapy in patients with surgically treated T4 esophageal squamous cell carcinnoma].
BACKGROUND
Esophageal cancer carries one of the poorest prognoses among digestive tract malignancies. Recent evidence suggests that the addition of nonsurgical treatment to surgery may improve resection rates, reduce the risk of recurrence, and improve survival.


METHODS
From August 1989 to December 2000, 69 patients with locally advanced (T4) esophageal squamous cell carcinoma were treated with combined 5-fluorouracil, cisplatin, and radiotherapy. Operative resections were achieved in 35 of 69 patients during surgical explorations. Preoperative chemoradiotherapy for patients with T4 esophageal cancer was effective in 27 of 35 (CR + PR: 77.1%), and a complete response (no tumor found in the surgical specimens) was observed in 7 of 35 (20.0%). Five-year survival was prolonged significantly based on the histological response rate (CR: 71%, PR: 32%, NC: 0%). The p-53 gene mutation was detected by the PCR-SSCP method. DNA sequences were determined for DNA fragments with shifted peaks by SSCP methods.


CONCLUSIONS
Radical esophagectomy after concomitant chemoradiotherapy is potentially curative for locally advanced esophageal carcinoma, and the p-53 genetic abnormality might be a good marker for chemoradiosensitivity (histological poor response) in patients with T4 esophageal cancer.
Shiozaki
Hitoshi
H
First Department of Surgery, Kinki University School of Medicine, Osaka, Japan.
Yano
Masahiko
M
D002294:Carcinoma, Squamous Cell / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D016158:Genes, p53 / Q000235:genetics; D006801:Humans; D009154:Mutation; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant