Myelotoxicity of preoperative chemoradiotherapy is a significant determinant of poor prognosis in patients with T4 esophageal cancer.
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.
Miyoshi
Norikatsu
N
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Yano
Masahiko
M
Takachi
Ko
K
Kishi
Kentaro
K
Noura
Shingo
S
Eguchi
Hidetoshi
H
Yamada
Terumasa
T
Miyashiro
Isao
I
Ohue
Masayuki
M
Ohigashi
Hiroaki
H
Sasaki
Yo
Y
Ishikawa
Osamu
O
Doki
Yuichiro
Y
Imaoka
Shingi
S
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
D004317:Doxorubicin; D002945:Cisplatin; D005472:Fluorouracil