Prospective non-randomized trial comparing esophagectomy-followed-by-chemoradiotherapy versus chemoradiotherapy-followed-by-esophagectomy for T4 esophageal cancers.
OBJECTIVE
Multimodal treatment is commonly adopted for patients with a T4 esophageal cancer. This trial evaluated which therapy offered a better survival: preoperative chemoradiotherapy (CRT) or postoperative CRT.


METHODS
Forty-three patients with a T4 esophageal cancer were enrolled in a prospective study in which each patient decided for themselves a treatment arm, CRT-followed-by-esophagectomy or esophagectomy-followed-by-CRT. The CRT-followed-by-esophagectomy Group received 36 Gy radiotherapy and simultaneous chemotherapy using cisplatin (CDDP) and 5-fluorouracil (5FU) preoperatively, and then 24 Gy radiotherapy and simultaneous chemotherapy using CDDP and 5FU postoperatively. The esophagectomy-followed-by-CRT Group received 60 Gy radiotherapy with two cycles of simultaneous chemotherapy using CDDP and 5FU postoperatively.


RESULTS
Of 26 patients who chose CRT-followed-by-esophagectomy, 15 (58%) underwent esophagectomy, while 7 (27%) refused surgery and 4 (15%) were inoperable. Of 17 patients who chose esophagectomy-followed-by-CRT, 14 (82%) underwent esophagectomy, while 3 (18%) underwent inspection thoracotomy. The CRT-followed-by-esophagectomy Group showed a significantly better 5-year-survival rate than the esophagectomy-followed-by-CRT Group (26% vs. 0%). Multivariate analysis demonstrated that only the response to CRT was prognostic.


CONCLUSIONS
This trial concluded that the first choice of treatment for patients with a T4 esophageal cancer was prior CRT rather than prior esophagectomy.
Fujita
Hirmasa
H
Department of Surgery, Kurume University School of Medicine, Kurume City, Fukuoka, Japan. fujita@med.kurume-u.ac.jp <fujita@med.kurume-u.ac.jp>
Sueyoshi
Susumu
S
Tanaka
Toshiaki
T
Tanaka
Yuichi
Y
Sasahara
Hiroko
H
Shirouzu
Kazuo
K
Suzuki
Gen
G
Hayabuchi
Naofumi
N
Inutsuka
Hiroki
H
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome
D002945:Cisplatin; D005472:Fluorouracil