title: Myelotoxicity of preoperative chemoradiotherapy is a significant determinant of poor prognosis in patients with T4 esophageal cancer.
abstract: OBJECTIVE
  Currently, preoperative chemoradiotherapy followed by surgery is the only promising strategy for patients with T4 esophageal cancer. This study retrospectively analyzed the prognostic factors in patients with curatively resected cancer after chemoradiotherapy.
  
  
  METHODS
  Between September 1989 and December 2003, 42 patients with T4 esophageal cancer received preoperative chemoradiotherapy (CRT) followed by curative surgery. Chemotherapy consisted of 5-fluorouracil/cisplatin (FP) or 5-fluorouracil/adriamycin/cisplatin (FAP). A total dose of 40 Gy of radiation was delivered concurrently. Surgery was scheduled 4 weeks after the completion of CRT. The treatment response was categorized using general criteria. Toxicities of the CRT were assessed according to National Cancer Institute of Common Toxicity Criteria (NCI-CTC). Univariate and multivariate analyses were performed to identify significant prognostic clinicopathological factors.
  
  
  RESULTS
  The overall survival rate was 38.4% at 5 years. The toxic grade for leukopenia (grade 0-2/3-4) and pathological effect (grade 3/1-2) were significantly different by univariate analysis (P = 0.03 and 0.05, respectively). Multivariate analysis identified the toxic grade for leukopenia as the only significant and independent determinant of prognosis (P = 0.05).
  
  
  CONCLUSIONS
  In patients with T4 esophageal cancer who receive CRT followed by curatively resection, myelogenic chemotoxicity is a significant prognostic factor.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Norikatsu
authors.initials: N
authors.lastname: Miyoshi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Ko
authors.initials: K
authors.lastname: Takachi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Yo
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Shingi
authors.initials: S
authors.lastname: Imaoka
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007970:Leukopenia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011292:Premedication; D011300:Preoperative Care; D011379:Prognosis; D011829:Radiation Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil