title: Chemoradiotherapy for T3 and T4 squamous cell carcinoma of the esophagus using low-dose FP and radiation: a preliminary report.
abstract: We conducted this study to evaluate the clinical significance of preoperative concurrent chemoradiotherapy (CRT) followed by esophagectomy in the management of T3 and T4 esophageal cancer. Thirty patients with squamous cell carcinoma of the esophagus received CRT followed by surgery. Preoperative CRT consisted of 5-fluorouracil (500 mg/m(2) by 24 h infusion for 5 days), cisplatin (15 mg/m(2) on days 1-5), and concurrent radiotherapy (a total dose of 40 Gy delivered in daily fractions of 2 Gy, 5 times per week). Esophagectomy was planned for 4-6 weeks after treatment and restaging. All 30 patients completed preoperative CRT. A clinical response (PR+CR) of the primary tumor was obtained in 82.8%, and a response of metastatic nodes was seen in 23.1%. Radical resection was possible in 17 of 29 operated patients (58.6%). The postoperative mortality rate was 6.9%, and the hospital mortality rate was 10.3%. Ten out of 29 operated patients (34.5%) had no residual cancer in the resected esophagus, corresponding to pathological CR. The 1-year survival rate was 80.6%, the 2-year survival rate was 62.7%, and the 3-year survival rate was 53.8%. The clinical response group and the R0 or R1 group showed better survival than other patients. Preoperative CRT should be given to patients with squamous cell carcinoma, while esophagectomy remains the standard therapy for responders and has a tolerable mortality.
authors.affiliation: Second Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663, Japan. fujiwa2s@hyo-med.ac.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Norihiko
authors.initials: N
authors.lastname: Kamikonya
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Kenji
authors.initials: K
authors.lastname: Koishi
authors.forename: Reigetsu
authors.initials: R
authors.lastname: Yoshikawa
authors.forename: Koji
authors.initials: K
authors.lastname: Nakao
authors.forename: Ryuuichirou
authors.initials: R
authors.lastname: Yagyu
authors.forename: Manabu
authors.initials: M
authors.lastname: Nishiwaki
authors.forename: Masayuki
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Shoudou
authors.initials: S
authors.lastname: Kojima
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakagawa
authors.forename: Takehira
authors.initials: T
authors.lastname: Yamamura
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin; D005472:Fluorouracil