title: Esophagectomy: is it necessary after chemoradiotherapy for a locally advanced T4 esophageal cancer? Prospective nonrandomized trial comparing chemoradiotherapy with surgery versus without surgery.
abstract: The need for surgery after chemoradiotherapy for a T4N0-1M0 squamous cell carcinoma in the thoracic esophagus was evaluated. A series of 53 patients were enrolled in this prospective nonrandomized trial from among 124 patients with an esophageal cancer assessed as T4 in Kurume University Hospital from 1994 to 2002. After the first chemoradiotherapy cycle, which consisted of radiotherapy in a total dosage of 36 Gy and chemotherapy using cisplatin (CDDP) and 5-fluorouracil (5FU), the patients each decided, after being informed of the efficacy of the chemoradiotherapy, whether to undergo surgery. All patients, including those who had undergone surgery and those who had not, later underwent a second chemoradiotherapy cycle consisting of radiotherapy in a total dosage of 24 Gy and chemotherapy using CDDP and 5FU, as far as practicable. Among the responders to the first chemoradiotherapy cycle, there was no significant difference in the long-term (5-year) survival rate between the 18 patients who underwent esophageal surgery and the 13 patients who did not (23% vs. 23%). Among the nonresponders, the 11 patients who underwent surgery showed a tendency toward longer survival than the five patients who had had no surgery. The nonresponders had 1- and 2-year survival rates of 64% and 33%, respectively. The corresponding rates for the 5 nonsurgical patients who completed the two chemoradiotherapy cycle were 20% and 20%, respectively. For a T4N0-1M0 squamous cell carcinoma in the thoracic esophagus, full-dosage chemoradiotherapy (definitive chemoradiotherapy) is preferred for responders to a half-dose of chemoradiotherapy as much as esophagectomy, whereas esophagectomy may be preferred for nonresponders.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011 Japan. fujita@med.kurume-u.ac.jp
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Fujita
authors.forename: Susumu
authors.initials: S
authors.lastname: Sueyoshi
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Satoru
authors.initials: S
authors.lastname: Matono
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirouzu
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamana
authors.forename: Gen
authors.initials: G
authors.lastname: Suzuki
authors.forename: Naofumi
authors.initials: N
authors.lastname: Hayabuchi
authors.forename: Masasuke
authors.initials: M
authors.lastname: Matsui
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D006801:Humans; D011446:Prospective Studies; D016896:Treatment Outcome