Preoperative chemoradiotherapy for squamous cell carcinoma and adenocarcinoma of the esophagus: a phase II study.
OBJECTIVE
This study evaluated the concurrent treatment of chemoradiation followed by esophagectomy in the management of locoregional esophageal carcinoma. The main end points were to determine the resectability of the tumor and the pathologic tumor response. An accessory aim was to evaluate the survival rate.


METHODS
Thirty-nine patients were treated as follows: 5-fluoruracil, 1,000 mg/m(2), by 24-h IV infusion for 4 days, and cisplatin, 100 mg/m(2), on day 1. Concurrent radiotherapy was delivered at a total dose of 40 Gy in daily fractions of 2 Gy five times per week. The performance of an esophagectomy was planned 4 weeks after induction treatment and restaging.


RESULTS
All patients completed the preoperative treatment. A potentially radical resection was performed in 29 patients, and a complete or partial histologically proven response was observed in 9 patients (23%) and 20 patients (51%), respectively. The 3-year overall survival rate was 40%. The 3-year rates of overall survival and disease-free survival were 88% and 76%, respectively, in patients with complete response (p < 0.0012), and 16% and 17%, respectively, in patients with partial response (p < 0.0013). Age, histology, and response represented the best prognostic model related to survival.


CONCLUSIONS
The results of this combined approach appear to be better than those reported with surgery alone. Despite the small number of patients in the series and the inclusion of patients with different histotypes, we concluded that patients with the squamous histotype show a better outcome than those with adenocarcinoma.
De Vita
Ferdinando
F
Division of Medical Oncology, F. Magrassi Department of Clinical and Experimental Medicine, Second University of Naples School of Medicine, Via Pansini 5, 80131 Naples, Italy.
Di Martino
Natale
N
Orditura
Michele
M
Cosenza
Angelo
A
Galizia
Gennaro
G
Del Genio
Alberto
A
Catalano
Giuseppe
G
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D016896:Treatment Outcome
D002945:Cisplatin; D005472:Fluorouracil